Community health workers in Kenya are tracing ART defaulters at the household level and effectively referring them to comprehensive care centers to improve retention in HIV care and treatment. Through mapping communities and working with peer educators, health workers have identified over 90% of defaulters and ensured 100% are referred for care. This has increased the number of defaulters traced and retained in care. Defaulter tracing combined with referrals gives health workers a platform to link and support clients to stay in treatment. Strengthening referral networks and supporting health workers in tracing defaulters could further increase HIV testing and care in rural areas.

1. The Role of Community Health Workers in Enhancing
Care and Treatment through defaulter tracing and effective
referrals
Presenter: Christine Nzilani, Aphiaplus KaMili
(Kenya Red Cross)
NOPE 6th Biennial International Conference on Peer Education, Sexuality,
HIV&AIDS
KICC, 18th-20th June 2014.

2. Outline of Presentation
• Background
• Objective
• Description and Methodology
• Lessons Learned
• Next Steps
• Questions and Answers

3. Background
• Defaulter tracing for clients on ART is one of the activities
embarked on by Community Health Workers at household level to
reach clients who have dropped from care and treatment .
• Improving defaulter tracing and effective referrals and subsequent
linkage to care and treatment is a key priority in scaling up HIV
services. Unfortunately, defaulter tracing and effective referral with
a focus to linkage to care and treatment in health facilities has
remained a major challenge due to stigma associated with being
HIV positive

4. Background
• This has resulted in low enrolment rates and in other
cases clients who are enrolled into care and treatment
drop out.
• Defaulter tracing and effective referrals are an
important strategy in encouraging increased and
sustained uptake of care and treatment.
• Community Health Workers through APHIAPLUS
KAMILI trace and refer ART defaulters as an approach
for retention of HIV clients in Kiambu County.

5. Objective
• To identify at least 90% of ART defaulters,
ensure 100% effective referral and linkage to
Comprehensive Care Centres (CCC) in order
to increase retention on care.

6. Description and Methodology
• House hold mapping and registration has been done
which is one of the ways the CHWs are able to
identify ART defaulters.
• CHWs work closely with the peer educators based at
the Comprehensive Care Centres in the link health
facilities to identify specific defaulters.

7. Description and Methodology
• Signs have been placed at link facilities that instruct
patients where to find the Comprehensive Care
Centres without difficulty once they have been
referred.
• 743 clients are currently on care in Ngoliba, Ithanga
and Munyu Health Centres.

9. Lessons learned
• There has been an increment in the number of
ART defaulters traced, referred and retained
through household visits by community health
workers .

11. Lessons Learned Cont…
• Defaulter tracing, when combined with effective
referrals provides a platform for Community
Health Workers to link and support clients and
ensure retention on care.

12. Lessons Learned Cont…
• Defaulter tracing and referrals, when
implemented within Community Units has the
potential to substantially increase uptake of HIV
testing and subsequently linkage to care in the
hard to reach rural areas of Kenya.

13. Next Steps
• There is need to strengthen existing referral
linkages for those testing HIV positive within the
community.
• Community Health workers should be supported
across the board to trace and effectively refer
ART defaulters.

14. Next Steps
If one CHW voice is a
powerful statement,
how about 1000?

15. Thank You!
Any Questions?