TY - JOUR
T1 - A multi-site community randomized trial of community health workers to provide counseling and support for patients newly entering HIV care in rural Ethiopia
T2 - study design and baseline implementation
AU - Lifson, Alan R.
AU - Workneh, Sale
AU - Hailemichael, Abera
AU - MacLehose, Richard F.
AU - Horvath, Keith J.
AU - Hilk, Rose
AU - Fabian, Lindsey
AU - Sites, Anne
AU - Shenie, Tibebe
N1 - Publisher Copyright:
© 2018 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2018/5/4
Y1 - 2018/5/4
N2 - Background: Although HIV therapy is delivered to millions globally, treatment default (especially soon after entering care) remains a challenge. Community health workers (CHWs) can provide many services for people with HIV, including in rural and resource-limited settings. Objectives: We designed and implemented a 32 site community randomized trial throughout southern Ethiopia to assess an intervention using CHWs to improve retention in HIV care. Methods: Sixteen district hospital and 16 local health center HIV clinics were randomized 1:1 to be intervention or control sites. From each site, we enrolled adults newly entering HIV care. Participants at intervention sites were assigned a CHW who provided: HIV and health education; counseling and social support; and facilitated communication with HIV clinics. All participants are followed through three years with annual health surveys, plus HIV clinic record abstraction including clinic visit dates. CHWs record operational data about their client contacts. Results: 1799 HIV patients meeting inclusion criteria were enrolled and randomized: 59% were female, median age = 32 years, median CD4 + count = 263 cells/mm 3 , and 41% were WHO Stage III or IV. A major enrollment challenge was fewer new HIV patients initiating care at participating sites due to shortage of HIV test kits. At intervention sites, 71 CHWs were hired, trained and assigned to clients. In meeting with clients, CHWs needed to accommodate to various challenges, including HIV stigma, distance, and clients lacking cell phones. Conclusions: This randomized community HIV trial using CHWs in a resource-limited setting was successfully launched, but required flexibility to adapt to unforeseen challenges.
AB - Background: Although HIV therapy is delivered to millions globally, treatment default (especially soon after entering care) remains a challenge. Community health workers (CHWs) can provide many services for people with HIV, including in rural and resource-limited settings. Objectives: We designed and implemented a 32 site community randomized trial throughout southern Ethiopia to assess an intervention using CHWs to improve retention in HIV care. Methods: Sixteen district hospital and 16 local health center HIV clinics were randomized 1:1 to be intervention or control sites. From each site, we enrolled adults newly entering HIV care. Participants at intervention sites were assigned a CHW who provided: HIV and health education; counseling and social support; and facilitated communication with HIV clinics. All participants are followed through three years with annual health surveys, plus HIV clinic record abstraction including clinic visit dates. CHWs record operational data about their client contacts. Results: 1799 HIV patients meeting inclusion criteria were enrolled and randomized: 59% were female, median age = 32 years, median CD4 + count = 263 cells/mm 3 , and 41% were WHO Stage III or IV. A major enrollment challenge was fewer new HIV patients initiating care at participating sites due to shortage of HIV test kits. At intervention sites, 71 CHWs were hired, trained and assigned to clients. In meeting with clients, CHWs needed to accommodate to various challenges, including HIV stigma, distance, and clients lacking cell phones. Conclusions: This randomized community HIV trial using CHWs in a resource-limited setting was successfully launched, but required flexibility to adapt to unforeseen challenges.
KW - Ethiopia
KW - community health workers
KW - community randomized trials
KW - human immunodeficiency virus
KW - retention in care
KW - rural care
KW - sub-Saharan Africa
UR - http://www.scopus.com/inward/record.url?scp=85047264947&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047264947&partnerID=8YFLogxK
U2 - 10.1080/15284336.2018.1461999
DO - 10.1080/15284336.2018.1461999
M3 - Article
C2 - 29688139
AN - SCOPUS:85047264947
SN - 1528-4336
VL - 19
SP - 112
EP - 119
JO - HIV Clinical Trials
JF - HIV Clinical Trials
IS - 3
ER -