Background: In June 2017, Botswana introduced ''Treat all'' to facilitate universal coverage of antiretroviral treatment (ART) towards the 90-90-90 targets. Treat all provides access to ART to Botswana citizens irrespective of CD4 count. FHI 360, Advancing Partners and communities (APC) project, funded by PEPFAR through USAID in Botswana built the capacity of communities towards epidemic control by introducing community health workers (CHWs) to support health facilities trace patients with known sero-positive status who never started ART and defaulters, in eight districts. Health facility staff traditionally trace defaulters through phone calls.
Description: Working in collaboration with the Ministry of Health & Wellness (MoHW) District Health Management Teams (DHMTs), CHWs were trained on community HIV care including patient tracking strategies and provided standard operating procedures (SOPs) for guidance. Senior Community Health Workers (SCHWs) were posted in health facilities and together with nurses in the infectious Disease Control Centres (IDCC) identified patients that were in the registers but never started ART or defaulted.
A team of CHWs was assigned a caseload of patients to track in the community. Successfully traced patients were linked to facilities through unaccompanied and accompanied referrals. They were also provided information on “Treat All” to support them to opt for ART initiation.
Lessons learned: During the period October 2016 to September 2017, out of 1,277 clients referred to APC CHWs for tracing, 584 (46%) included sufficient information in their clinical file for tracing. From those traced, 317 (54%) linked back to health facilities and initiated on ART, 146 (25%) were found already on ART, 46 (8%) were referred but did not link, 40 (7%) had changed physical address, 27 (5%) declined to be linked back to care, and eight were reported deceased.
Conclusions/Next steps: Implementation of community patient tracking contributed to linkage of PLHIV to ART and updating patient facility records. Home visits by CHWs increases uptake of ART services. CHWs are critical to fill the human resource constraints within the health system and their knowledge of their community ensures successful tracing of those lost by the health system. Tracking patients that have defaulted from ART is resource intensive but worth it.