Peer Educators Impact of HIV Medicine Adherence
Principal Investigator:
- William A. Blattner, M.D.,
University of Maryland Biotechnology Institute
Co-Investigator:
- Maria K.L. Eng, Dr.PH.,
University of Maryland Biotechnology Institute
Abstract
Peer educators—those infected with HIV/AIDS and/or those who share the same socioeconomic or cultural background as the local AIDS populations— are effective advocates and partners for medication treatment adherence and represent a cost effective and proven labor source for supporting adherence programs. These community-based educators can also resolve barriers to medication adherence (such as stigma, low self-esteem, and adverse drug side effects) and improve pill taking behaviors since they are familiar with the disease and local culture and attitudes towards ARV treatment.
This project explores the effectiveness and sustainability of two community-based peer educator interventions compared to hospital-based standard care practices. The hospital services a largely Muslim population in northern Nigeria and is a collaborator with the President's Emergency Plan for AIDS in Africa (PEPfAR).
We have two aims. The first aim is to compare HIV medication adherence between three different interventions: (1) typical HIV care, support and education as offered by the hospital's adherence staff; (2) daily medication reminders via text messaging from peer educators and encouragement and observation of daily adherence by a home-based treatment coach; or (3) activities as mentioned in 2 plus home visits by peer educators via motorcycle.
The second aim is to determine how sustainable these interventions are by evaluating the patient's continuity in the program and their clinical, virologic and immunologic improvement. Since excellent adherence is important from the beginning of treatment, we will target those HIV-infected adults who have been newly prescribed HIV medications.
This study is relevant because aside from anecdotal evidence, few studies have demonstrated that peer educators are effective. We attempt to demonstrate that (1) peer educators who support and guide home-based adherence can significantly improve HIV medication adherence when compared to a facility-based adherence support service, and (2) community-based peer educator outreach models are sustainable in the Nigerian context of low education, high levels of stigma, and limited resources and infrastructure. This will hopefully provide evidence-based data for adjusting HIV treatment adherence standards of care.