Table 1 Comparison of peer-delivered linkage case management (CommLink) and peer-delivered standard linkage services (SLS)
Services | CommLinka | SLSb |
|---|---|---|
Point-of-diagnosis peer-delivered HIV psychosocial support, counseling on the importance of early enrollment in HIV care and ART initiation, and referral to a healthcare facility appropriate to meet client needs. HIV-positive peer counselors of both programs received the same Ministry of Health training on HIV/AIDS, and providing psychosocial support and ART-adherence counseling | Routine | Routine |
Point-of-diagnosis HIV medical services including CD4 testing, WHO staging, and provision of 7-day supply of cotrimoxazole. Community-based ART initiation was not approved by the Eswatini Ministry of Health and was never provided by CommLink nurses | Routine | Never |
Follow-up telephone calls to assess well-being and coping, answer questions about HIV/AIDS, encourage and support enrollment and retention in care, remind clients of upcoming appointments, coordinate treatment navigation (CommLink only), and schedule and coordinate testing of sexual partners and family members (CommLink only) | Weekly through end of case management | At least once 3–5 days after HIV diagnosis |
One-time free transportation services to referral healthcare facility | Upon request | Upon request |
Personal escort and peer-delivered treatment-navigation services at facilities where clients enrolled in HIV care. CommLink peer counselors stayed with their client for the duration of at least their first healthcare visit, and most met their clients at a second or third visit to confirm antiretroviral refills. As part of treatment navigation, they introduced clients to facility-based ART adherence counselors and healthcare staff, and ensured they understood the stations and sequence of care and when and how best to access care at specific facilities. Peer counselors also provided adherence counseling for cotrimoxazole and ART and helped affect transfers to other facilities when needed | Routine | Upon request |
At least two follow-up peer-delivered face-to-face sessions to provide psychosocial support and informational, motivational, and ART-adherence counseling; assess and resolve real and perceived barriers to care; and support disclosure to and testing of partners and family members when safe and appropriate | Routine | Never |
Peer-delivered assessment and resolution of real and perceived barriers to enrollment and retention in care. Peer counselors used a standard form to record up to 13 different barriers to enrollment or retention in HIV care (CommLink only). Identification and resolution of real and perceived barriers was conducted as part of client-centered counseling | All sessions and during telephone follow-up | First session and telephone follow-up |
Index-client testing services to support disclosure and facilitate HIV testing of partners and family members when safe and appropriate | Peer- and HTS-counselor supported | HTS-counselor supported |