"They feel like they have found a friend, and they are able to open-up and talk more": A qualitative study on the role of Expert Clients and Health Promotion Officers in providing ART adherence support at Lighthouse Trust Clinics in Malawi

The study examined the role of Expert Clients and Health Promotion Officers (HIV-positive individuals) who provide counseling to other patients during their first 12 months of antiretroviral therapy at Lighthouse Trust clinics in Lilongwe, Malawi. The research was conducted through ten interviews with these support workers. Findings showed that these workers build trust with patients, respect cultural sensitivities, and disclose their own HIV status to promote openness and treatment continuation. Major barriers to patient retention include social stigma and clients' socioeconomic status. Workers recommended implementing non-judgmental re-engagement strategies for patients who interrupted treatment, reducing administrative burden, and using radio and television to broadcast adherence messages. The study emphasizes the need to create a supportive clinic environment that motivates patients to return to treatment even after treatment gaps.