ZPCT - Adherence Support Worker (ASW) Program

Category 3

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Under the Zambia Prevention, Care and Treatment Partnership (ZPCT), volunteer adherence support workers (ASWs) encourage treatment adherence among patients on antiretroviral therapy (ART) and provide education, counseling, and support for patients in their own language, freeing clinicians to attend to other activities. Most ASWs, who are selected by district-level health officials, health facility staff, and community members, are living with HIV and are currently on ART themselves. They spend two days a week at ART clinic sites, and a third in the community, where they provide HIV education, treatment support, adherence counseling, and follow-up for treatment defaulters. Perhaps their most important role, though, is serving as positive examples of PLWH who are on treatment.

Goal of the Practice
  • The involvement of people living with HIV on the treatment team builds human resources capacity as it creates a sustainable model of high-quality HIV service delivery.
Core Components
  • A two-week intensive course teaches community volunteers to work alongside nurses and doctors. ASWs learn to interact with patients in clinical, community, and home settings, where they provide HIV education, treatment support, and ART adherence counseling. They also learn how to work within the referral network. On community outreach days, ASWs receive a list of treatment defaulters with whom to follow up to encourage re-engagement at the clinic.
  • Adherence support workers work three days per week, receiving up to $30 per month for transportation reimbursements. ZCPT also purchased a couple of bicycles for each health facility that ASWs can share for community outreach.
Noteworthy Results
  • As of 2008, 273 ASWs had been trained.
  • Retention of ASWs is good. As of 2008, only 22 of the 273 trained ASWs had ended their participation.
  • An evaluation of the ASW program found that the quality of adherence counseling by ASWs was comparable to that of health care workers.
  • The evaluation also suggests that the deployment of ASWs helped reduce waiting times for adherence counseling, and loss to follow-up rates of new clients declined from 15% to 0% after the deployment of ASWs.
Lessons Learned
  • Shifting such tasks as adherence counseling, education, and support to ASWs frees doctors and nurses to attend to other clinical needs, which contributes to a sustainable model of human resource capacity.
  • Recruiting PLWH on treatment to become ASWs builds trust and increases support among newly diagnosed patients.
  • One key to program success is working within the ministry structure. Implementing partners should provide training and technical assistance for the program, but should ensure that the ministry, not the implementing partner, owns the program.
  • Follow-up of ART clients by ASWs within the community is necessary to improve retention of clients on ART.
Focus Areas
Care and SupportTreatment
Implemented By
Family Health International
Participating Organization
  • Management Sciences for Health
  • Churches Health Association of Zambia
  • Kara Counseling and Training Trust
  • CARE International
  • The Salvation Army
  • Emerging Markets Group
  • Social Impact
  • University Teaching Hospital Zambia
  • Network of Zambian People Living with HIV/AIDS
Clinic/Health facility
Target Population
General Public
> 50000
Implementation Years
07/2006 - ongoing