An integrated support model for lay health care workers to improve patients’ retention to HIV care

Abstract

The Purpose of the study The purpose of the study was to develop an integrated support model for lay health care workers (LHWs) to improve retention to HIV care. The study followed a qualitative approach and an exploratory, descriptive, and contextual design. Study population and sample The study population was formed by three groups that were then sampled purposively to facilitate the achievement of objectives: 22 LHWs; 10 supervisors and nurses; and 15 clients on ART; but data saturation guided the sample size. Data collection and data analysis methods Data collection was done through in-depth individual interviews and focus group discussions. Face-to-face and telephonic interviews were conducted with the efforts to observe COVID-19 precautionary measures. Field notes made by the researcher to indicate non-verbal cues from participants, as well as audio recordings were transcribed verbatim into Word documents, followed by conducting thematic data analysis. Results Common findings related to the retention experiences across the 3 groups of participants highlighted the commendable work done by the LHWs in HIV counselling, information provision, household visits and tracing of clients who missed their clinic appointments. However, the retention efforts are challenged by the limited support experienced by LHWs, as characterised by the lack of patient-centric care in health care facilities; limited provision of updated HIV information, collaboration, and communication from other health care workers; limited work resources; low stipends and lack of debriefing. The support model was then developed using literature and findings from the participants, with LHWs as the recipients, and their supervisors, nurses, and Department of health as agents of support. Dynamics that positively drive support were identified as communication, positive relationships, emotional stability, and willingness; challenged by power imbalance, lack of trust and respect, as well as low self-esteem. Contribution Different LHWs assume various key roles along the HIV care continuum, but their support is minimal. The model has the potential to improve the LHWs’ HIV care skills; contribute to the retention of clients to HIV care, United Nations’ goal of 95% viral load suppression, thereby improving the quality of life and reducing new HIV infections.