Engaging communities in supporting HIV prevention and adherence to antiretroviral therapy in Zambia
29 February 2008
Samuels, Fiona, Joseph Simbaya, Avina Sarna, Scott Geibel, Phillimon Ndubani, and Jolly Kamwanga.
Population Council
In Zambia, the prevalence of HIV has been estimated to be 16 percent among 15–49 year olds. In 2005, more than a million adults and children in the country were living with HIV, and nearly 10 percent of this group were dying from the disease (WHO 2006).
Recognizing the urgent need for antiretroviral therapy (ART), the Government of the Republic of Zambia (GOZ) has taken important steps to increase access to ART around the country, including making ART and associated laboratory tests free of charge at public health facilities (GOZ 2005). As a result, the number of people receiving ART has increased from 8,500 in June 2004 to a total of 115,000 by July 2007.
Because of the increased demands resulting from the scaling up of ART, it is clear that the formal health system alone cannot carry out all the steps necessary to get large numbers of people to initiate and maintain treatment successfully, and to prevent further transmission of HIV. Therefore, innovative approaches are necessary to ensure effective coordination between hospitals, clinics, and communitybased education and support services.
This summary presents findings from an operations research study to assess the outcomes of the Antiretroviral Community Education and Referral (ACER) Project in two urban areas in Zambia—Lusaka and Ndola. The ACER project was implemented by the International HIV/AIDS Alliance, based in England, and the Alliance’s Zambia office, in conjunction with local Zambian partners. Launched in mid-2004, the two-year project built on previous formative research with urban and rural communities that examined knowledge and attitudes about prevention and treatment (International HIV/AIDS Alliance 2003).
ACER was the Alliance’s first attempt to put into practice a community engagement strategy to foster HIV prevention, treatment, care, and support for people living with and affected by HIV/AIDS. Community engagement involves bringing together people with HIV, community stakeholders, and health providers to develop partnerships, address service
gaps and difficulties, and support families and individuals, with the following aims:
- Increase community awareness of available HIVrelated services.
- Increase access to and use of those services through referral systems.
- Increase community understanding of the connections between HIV prevention, care, and treatment.
- Support individuals to successfully adhere to treatment and practice preventive behaviors.
- Support health care workers to deliver services and to help meet their own health needs.
The research was conducted by the Institute of Economic and Social Research (INESOR) in Zambia and the Horizons Program. This summary addresses the following key research questions of the study:
- Among people on ART and community members, what are their levels of knowledge about HIV and ART, uptake of HIV testing, serostatus disclosure, adherence to ART, sexual risk-reduction behavior, and stigma, and how have these levels changed over time?
- What has been the effect of the ACER Project on the above outcomes among individuals on ART and community members?
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