Volunteer Escorts in Nigeria: A Key Link to HIV Treatment and Care

 {Photo credit: Aor Ikyaabo/MSH}MSH staff member, Christopher Ogar, verifies information from a HIV testing services register with facility staff at General Hospital Suleija in Niger state, Nigeria.Photo credit: Aor Ikyaabo/MSH

In Nigeria, home to the world’s second-largest HIV epidemic, successfully linking every person who tests positive for HIV to accessible and culturally appropriate care and support services is a big challenge.

Gender and sociocultural norms can create barriers to linkage, particularly in northern states of Nigeria such as Kebbi, where some women need permission from their husbands to start treatment. Systemic barriers also play a role; a prevention of mother-to-child transmission site that provides testing services to family, partners, and at-risk individuals may only provide treatment services to pregnant women and refer other clients, such as men or youth, to another facility to initiate treatment.

However, effectively linking people to care and treatment services is critical to achieving epidemic control. Starting and staying on treatment makes it possible for HIV-positive individuals to live healthy lives without the risk of infecting others or transmitting the virus to their children.

The USAID-funded Care and Treatment Support Services (CaTSS) project, led by Management Sciences for Health (MSH), has improved linkage to antiretroviral therapy (ART) services by enlisting facility champions working as peer navigators and client escorts at high-volume sites. In Kebbi state, this approach has led to a marked improvement in overall linkage to treatment and care, from 82.85% in September 2018 to 100% in March 2019.This achievement would not have been possible without the dedication of facility champions like 37-year-old Sanusi Garba.

[Sanusi Garba, health worker at General Hospital Aliero, Nigeria. Photo Credit: Aor Ikyaabo/MSH}Sanusi Garba, health worker at General Hospital Aliero, Nigeria. Photo Credit: Aor Ikyaabo/MSH

Sanusi, a laboratory health worker, provides HIV testing services at General Hospital Aliero in Kebbi. Knowing that General Hospital Aliero does not provide ART, Sanusi joined the ranks of volunteers who escort HIV-positive patients to General Hospital Jega, the nearest comprehensive ART facility.

To ensure that clients who are referred to a different facility are effectively enrolled in ART treatment, Sanusi explains that often company is key. “I personally, through available public transport, take such clients to General Hospital Jega and ensure that a confirmatory test is conducted and that same-day ART initiation is done as quickly as possible, just to boost their confidence in early treatment and care as the best course forward.” Sanusi often travels the 12 km between the two facilities with patients and calls ahead to the ART focal person at General Hospital Jega, giving him a heads-up to prepare for enrollment of a new patient onto ART. Between October 2018 and March 2019, Sanusi successfully linked 26 people to ART.

Over the next six months, the project team will apply and scale up lessons from Kebbi to increase the number of people who are successfully linked to treatment across all states supported by CaTSS.