The document summarizes a project in Kenya that used "mother mentors" or peer mentors to improve HIV treatment adherence. [1] Mentor mothers were trained to provide adherence counseling, trace patients who missed appointments, and conduct community outreach. [2] After implementing this approach, HIV retention improved from 36% to 85% and defaulter tracing success increased to 88%. [3] The peer mentoring model was effective at improving HIV care and treatment outcomes.

1. Dr. Judith Kose – Otieno
EGPAF Kenya Technical Director/ Op ARIFU lead
March 2013
Co- Authors: Lucy Wambugu1; Gacheri Muthuuri1; Anthony Kamau1;
Irene Mukui 2; Titus Syengo1
Affiliations: 1. Elizabeth Glaser Pediatric AIDS Foundation 2.
Ministry of Health
1

2. Background
• EGPAF-Kenya has implemented the Operation ARIFU
Project, a CDC-funded project working with Aids Control
Units (ACU) of Non-Military Uniformed Services (NMUS)
since 2008.
• The project aims to improve HIV care and treatment services
in 34 health facilities serving 121,000 uniformed services
personnel and their families.
• Adherence to HIV treatment is critical to reduction of HIV-
related morbidity and mortality, however, national retention
is 69%, with adherence at 12 months of 70%.
• Barriers to adherence: poor counseling, weak mechanisms to
follow clients, and limited client knowledge of ART benefits.
• Strategies to improve adherence: use of HIV clinic diaries to
help track patients, good adherence counseling
support, targeted treatment literacy sessions and defaulter

3. Methodology
• ARIFU adopted the peers in workforce approach to address
adherence barriers at 16 supported ARIFU sites countrywide.
• In October 2011, 20 HIV-positive mothers (mentor mothers)
from 16 supported sites were identified and trained by
EGPAF on: adherence counseling; ART defaulter tracing using
clinic diaries; treatment literacy; community PMTCT and
community prevention with positives interventions.
• Mentor Mothers received onsite quarterly mentorship by
program staff and monthly stipends of US$ 50 upon report
submission.
• Duties included adherence preparation and counseling, ART
defaulter identification using clinic diaries, tracing of
defaulters via phone calls and home visits and offering
treatment literacy sessions to HIV-positive clients.

4. 60
50
40
No. of reports
On Time
30 late
Not sent
20 mother mentor
10
0
Oct-Dec'11 Jan-Mar'12 Apr-Jun'12 Jul-Sept'12

5. • Reports not signed by facility manager
• Mother mentor was unwell and missed
some days
• Mother mentor dies (n=1)
• Mother mentor got a job elsewhere
(n=2)
• Reports lost in the courier system (later
resent)

6. Results
Number of clients per quarter
Indicator Dec 11 Mar 12 Jun 12 Sept 12 Total
Adherence preparation counseling 144 202 299 265 910
Assisted disclosure 53 90 116 279 538
Pregnant women linked to care 24 56 17 82 179
HIV-exposed infants linked to care 22 45 23 89 179
Community to facility referrals 56 3 96 83 238
Facility to community referrals 55 65 70 42 232
Missed HIV care appointments 23 33 49 93 198
Clients traced 15 21 33 76 145
Returnees to treatment 7 14 25 53 99

7. Results Continued
• By September 2012, ARV retention at these 16
supported sites improved from 36% to 85%;
• 90% of clients received three counseling
sessions, provided by mother mentors - under
guidance of facility staff, before treatment
initiation, per national standards; and
• 88% of identified defaulters were traced and
returned to treatment.

8. HIV Care and Treatment Data
Indicator 2011 2012
Reporting ART sites 11 17
Cumulative enrolled on HIV care
(men and women) 902 1234
Current on CTX 328 (36%) 998 (81%)
Newly enrolled on ARV 94 191
Cumulative on ARV 179 370
Current on ARV 71 (36%) 314 (85%)

9. Mother Mentors Workshop

11. Conclusions
• Use of peer mentors was associated with
improved adherence and retention in HIV
treatment at supported sites.

12. • The mother mentors

13. THANK YOU