The Role of Lay Workers in Providing Home-based Treatment Adherence Support to Patients with Advanced HIV Disease in Tanzania and Zambia

The present study tested an intervention using trained lay health workers and screening for cryptococcal meningitis and TB in Tanzania and Zambia through a randomised trial. Here, we give a detailed description of the care model with an emphasis on the role of the trained lay worker. To provide antiretroviral medications, offer adherence counselling, and perform basic monitoring for treatment side effects and other medical issues, lay workers made home visits to patients in the intervention arm. In 2019, there were appropriately 20.7 million [18.4 million–23.0 million] people living with HIV in Eastern and Southern Africa, and an estimated 72% of them were on antiretroviral therapy (ART). A major challenge in the scale-up of ART services in Sub-Saharan Africa is the severe shortage of human resources for health.

To provide antiretroviral medications, offer adherence counselling, and perform basic monitoring for treatment side effects and other medical issues, lay workers made home visits to patients in the intervention arm. A total of 1999 participants were enrolled in the trial. Lay workers were recruited through public advertisements.

Six lay workers were recruited in each country and trained for two weeks. Each lay worker was paid a monthly salary of US$ 524.83 in Zambia and US$ 537.54 in Tanzania. They were also paid communication and transport expenses for home visits. The median number of visits per patient was 3 for Tanzania and 4 for Zambia. On average a lay worker was responsible for 72.3 patients in Tanzania and 94.5 in Zambia for 1 year. Referrals were made in 9% of the home visits and self-referral was discouraged in 64% of visits.

According to this study, using paid lay people to deliver HIV/AIDS services in metropolitan areas where there is a clinical staffing shortage may assist identify ART-related side effects and adverse responses and save needless referrals.