I visited Masafu Hospital in eastern Uganda on a busy Tuesday morning. Tuesdays are antiretroviral therapy (ART) clinic days at this Ugandan facility. Patients come on their designated date for a checkup and to pick up their prescription refill. (Clients get a one month supply of medicines; ideally health workers see the HIV-positive clients once a month to check their health status.)
Three volunteer expert clients — Jessica, David, and Matuet — assist the trained health workers on clinic and non-clinic days.Jessica, David, and Matuet are members of the community, HIV-positive clients, and a key to HIV care and treatment at Masafu Hospital. (Photo credit: M. Hartley/MSH)
On ART-clinic days, Jessica, David and Matuet organize files, greet patients, inform patients about side effects, educate on prevention methods, support CD4 collection, and communicate with relatives. On non-clinic days, the expert clients reach out to the communities to reduce stigma, inform people about the services available at health centers, and encourage others to know their status.
David explains that he chose to become an expert client because, “I have the challenge too; I want to help others understand HIV better.”
Matuet said, “Other community members don’t want to know their status. I had to stand up.”
The expert clients also help locate and follow up with “lost-to-follow-up” clients — people who do not return to the health center for services due to stigma, distance, illness, or sometimes death. David, Jessica, and Matuet work with local networks in the community to locate the missing patients, counsel clients, and help them return to the health center.
David has been involved in community health and outreach for many years. He became an official expert client at Masafu Hospital after he was trained by Strengthening TB and AIDS Response – Eastern Region (STAR-E), a USAID-funded project led by Management Sciences for Health and partners throughout eastern Uganda.
“I was trained by the team and now I can offer counseling at people’s homes and assist with taking blood samples. I can help relieve the health workers when they are overwhelmed with patients,” David said. Seeing patients return for follow-up makes the effort worthwhile, he said.
David, Matuet, and Jessica said they would appreciate more training on communicating and counseling HIV-positive children and children of HIV-positive guardians or parents. There are a lot of children around the hospital: some waiting for their own treatment, and others accompanying a family member. Living with HIV or with family members with HIV holds unique challenges for a child. The expert clients want to be able to offer specific support to these clients.
Expert clients are a good solution to the human resource challenge many health facilities in Uganda face trying to properly manage the HIV burden. The opportunity also encourages the clients to live positively and have an impact on their own community. The expert clients can see the results of their outreach. Patients are coming in large numbers to the hospital for voluntary counseling and testing, and returning more regularly for ART.
STAR-E expands HIV & AIDS prevention, care and treatment activities in eastern Uganda through a family-centered approach which involves the facility, the community and the family in delivering care and treatment services to AIDS patients.
Margaret Hartley, knowledge exchange associate at MSH, was awarded the Gadue-Niebling-Urdaneta (GNU) Memorial Fellowship. She traveled to Uganda for four weeks, visiting local health centers and NGOs to meet with organizations MSH serves.
Editor’s note: MSH established the Gadue-Niebling-Urdaneta (GNU) Memorial Fund in memory of Cristi Gadue, Amy Lynn Niebling, and Carmen Urdaneta, to further the work to which these remarkable women dedicated their lives. Each year, the GNU Fellowship provides two MSH employees based in the US and globally with an international public health opportunity at another MSH location.