The added value of community-based organisations in retaining people living with HIV (PLHIV) in the continuum of care in Mali.

Abstract

Background: Retention in care of people living with HIV (PLHIV) is a crucial public health issue in Mali. Several barriers to retention have been highlighted, including socioeconomic status, gender, sexual orientation, HIV-related stigma, as well as organisational and structural barriers, such as public insecurity and sub-optimal public services. We explored the role of community health workers (CHWs) in PLHIV retention in care in Mali.

Methods: As part of the Cascades Communautaires project, eight focus groups (FG) and 20 individual interviews were conducted in 2021 among PLHIV at ARCAD Santé PLUS, a Malian community-based organisation (CBO). Participants included PLHIV who self-identified with key populations (KP) (men who have sex with men, female sex workers, people who inject drugs, and transgender women).

Results: Among the 60 PLHIV interviewed, 50% self-identified with KP. The median age and interquartile range were 35 years [28.5; 43.0] and 25% had a tertiary education. Four main themes emerged concerning CHWs' role in fostering retention in care: (i) Good patient-physician relationships in ARCAD Santé PLUS's structures; (ii) Social support between peers in the CBO; (iii) Peer educators (a sub-category of CHWs) as facilitators of continuous antiretroviral treatment distribution, and care and (iv) Free healthcare access in the CBO and financial support for transportation.

Conclusion: Peer educators play an essential role in PLHIV (general public and KP) retention in care in Mali in terms of psychosocial and logistical support. The non-judgmental approach of physicians working in CBO is also a major factor in retention.