Case study No. 4. Lay workers’ vital roles in supporting ART rollout: home-based care in Zambia

Abstract

The International HIV/AIDS Alliance, LSHTM, ZAMBART and AIDS Alliance Zambia have completed work on a study on Home Based Care (HBC) in Zambia. The study, an example of a successful collaboration between Evidence for Action partners, generated new data on the new roles of frontline lay health workers in Sub-Saharan Africa. The research focused on the changing role of home based care givers since antiretroviral therapy (ART) was introduced in Zambia. It found that the role of home-based caregivers has become more 'medicalised' since the introduction of ART. In addition to care and support in households, lay caregivers are now more directly involved in enabling and sustaining access to ART for PLHIV through tasks including: identifying, referring, and accompanying patients for testing and initiation on to ART; treatment counselling, adherence support and monitoring patients on ART. Home based care givers increasingly support the formal health system, and effectively create lasting linkages between PLHIV and the ART clinics. The findings of this research were communicated in various ways to key stakeholders, including home based care organisations; policy makers in the Zambian health service, and international organisations. They provide recognition and strong evidence for the important role of home-based care providers – often underpaid and undervalued – in supporting formal health systems for ART delivery