Evaluation of a Task-Shifting Strategy Involving Peer Educators in HIV Care and Treatment Clinics in Lusaka; Zambia

Rapid expansion of antiretroviral therapy (ART) and a shortage of health care workers (HCWs) required the implementation of a peer educator (PE) model as part of a task-shifting strategy in Lusaka District clinics. The purpose of this study was to evaluate patient and staff perceptions regarding whether the PE program: a) relieved the workload on professional HCWs; and b) delivered services of acceptable quality. Qualitative and quantitative data were gathered from five primary care clinics delivering ART in Lusaka; Zambia. Closed surveys were conducted with 148 patients receiving ART; 29 PEs; and 53 HCWs. Data was imported into Microsoft Excel to calculate descriptive statistics. Six focus group discussions and eight key informant (KI) interviews were conducted; recorded; transcribed; and coded to extract relevant data. Survey results demonstrated that 50 of 53 (96.1) HCWs agreed PEs reduced the amount of counseling duties required of HCWs. HCWs felt that PEs performed as well as HCWs in counseling patients (48 of 53; 90.6) and that having PEs conduct counseling enabled clinical staff to see more patients (44 of 53; 83). A majority of patients (141 of 148; 95.2) agreed or strongly agreed that PEs were knowledgeable about ART; and 89 of 144 (61.8) expressed a high level of confidence with PEs performing counseling and related tasks. Focus group and KI interviews supported these findings. PEs helped ease the work burden of HCWs and provided effective counseling; education talks; and adherence support to patients in HIV care. Consideration should be given to formalizing their role in the public health sector

Process Evaluation of School-based Peer Education for HIV Prevention Among Yemeni Adolescents

In 2005; a survey was conducted among all the 27 high schools of Aden; which revealed low levels of knowledge on major prevention measures; and a high level of stigma and discrimination towards people living with HIV (PLWH). The results served as a baseline for implementing a school-based peer education intervention for HIV prevention in the 27 schools of Aden. In 2008; and after 3 years of implementation; a quasi-experimental evaluation was conducted; which revealed that the peer education intervention has succeeded in improving HIV knowledge and skills; and in decreasing stigmatization of PLWH. This process evaluation aims to give a deeper understanding of the quasi-experimental evaluation which was conducted in the 27 high schools of Aden; and to highlight the factors that facilitated or inhibited school peer education in such a conservative Muslim setting. Qualitative methodologies were pursued; where 12 focus group discussions and 12 in-depth interviews were conducted with peer educators; targeted students; school principals; social workers; and parents of peer educators. Results revealed that school-peer education was well received. There was an apparent positive effect on the life skills of peer educators; but the intervention had a lesser effect on targeted students. Key enabling factors have been the high quality of training for peer educators; supportive school principals; and acceptance of the intervention by parents. These findings are important for improving the life skills and peer education intervention at the school level; and in better planning and implementation of life skills and peer programmes at a national scale

Workplace Peer Educators and Stress

Peer educators form an important component of company responses to HIV and AIDS. Based on interviews with peer educators working in and around a mining company in South Africa's North-West Province; the study examines the relationship between involvement in peer education and stress. The paper discusses how becoming a peer educator can be a response to the often personal stress brought about by the HIV epidemic. In addition; structural difficulties; skills deficiencies and other obstacles to effective communication with their peers can create stress. The stress that active peer education brings to individuals is discussed; particularly in regard to the embeddedness of peer educators within their communities. The need for confidentiality also magnifies stress in the case of individuals who disregard peer educators' advice. Peer educators face many stresses in managing and supporting their own lives; thus their (voluntary) work as peer educators should not be taken out of context. Using this approach; we discuss how the role of peer educator should be conceptualised and how they can be organised and supported in order that their stress be minimised and effective engagement maximised