1
|
Impact of Community Support Workers in Rural Ethiopia on Emotional and Psychosocial Health of Persons Living with HIV: Results of a Three-Year Randomized Community Trial. AIDS Behav 2023:10.1007/s10461-023-04007-1. [PMID: 36788166 DOI: 10.1007/s10461-023-04007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
People living with HIV face multiple psychosocial challenges. In a large, predominantly rural Ethiopian region, 1799 HIV patients new to care were enrolled from 32 sites in a cluster randomized trial using trained community support workers with HIV to provide individual health education, counseling and social support. Participants received annual surveys through 36 months using items drawn from the Centre for Epidemiologic Studies Depression Scale-10, Medical Outcome Study Social Support Survey, and HIV/AIDS Stigma Instrument-PLWA. At 12 months (using linear mixed effects regression models controlling for enrollment site clustering), intervention participants had greater emotional/informational and tangible assistance social support scores, and lower scores assessing depression symptoms and negative self-perception due to HIV status. A significant treatment effect at 36 months was also seen on scores assessing emotional/informational social support, depression symptoms, and internalized stigma. An intervention using peer community support workers with HIV to provide individualized informational and psychological support had a positive impact on the emotional health of people living with HIV who were new to care.(ClinicalTrials.gov protocol ID: 1410S54203, May 19, 2015).
Collapse
|
2
|
Lifson AR, Hailemichael A, Workneh S, MacLehose RF, Horvath KJ, Hilk R, Sites A, Slater L, Shenie T. A three-year randomized community trial of community support workers in rural Ethiopia to promote retention in HIV care. AIDS Care 2022; 34:1506-1512. [PMID: 35195481 PMCID: PMC9395549 DOI: 10.1080/09540121.2022.2029819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 01/12/2022] [Indexed: 01/26/2023]
Abstract
Retention in care is a major challenge for global AIDS control, including sub-Saharan Africa. In a large Ethiopian region, we evaluated an intervention where HIV positive community support workers (CSWs) provided HIV health education, personal counseling and social support for HIV patients new to care. We enrolled 1,799 patients recently entering care from 32 hospitals and health centers, randomized to intervention or control sites. Dates of all clinic visits, plus deaths or transfers were abstracted from HIV medical records. Primary outcomes were gap in clinical care (>90 days from a missed clinical or drug pickup appointment) and death. For 36 months of follow-up, and for the first 12 months after enrollment, weighted risk differences [RD] between treatment arms were modest and non-significant for gap in clinical care, death or either outcome. Through 36 months, 624 of 980 controls and 469 of 819 intervention participants had gaps in clinical care (RD = -5.5%, 95% confidence interval [CI] = -17.9%, 7.0%); 79 controls and 82 intervention participants died (RD = 2.5% 95% CI = -1.7%, 6.8%). Factors including HIV stigma and a volatile political climate may have attenuated the advantages we anticipated, demonstrating how benefits of CSW interventions may depend upon psychosocial, clinical and structural factors particular to specific community settings.
Collapse
Affiliation(s)
- Alan R Lifson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Abera Hailemichael
- Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia
| | - Sale Workneh
- Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Keith J Horvath
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Rose Hilk
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Anne Sites
- Global Program, National Alliance of State and Territorial AIDS Directors, Washington, DC, USA
| | - Lucy Slater
- Global Program, National Alliance of State and Territorial AIDS Directors, Washington, DC, USA
| | - Tibebe Shenie
- Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia
| |
Collapse
|
3
|
Li L, Lin C, Liang LJ, Song W, Pham LQ, Le TA, Nguyen TA. A community approach to promote healthcare services for people living with HIV who use drugs in Vietnam. Int J STD AIDS 2022; 33:164-172. [PMID: 34727808 PMCID: PMC10443225 DOI: 10.1177/09564624211053430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People living with HIV who use drugs (PLHWUD) face enormous challenges to access antiretroviral therapy (ART), addiction treatment, and other healthcare services. This study evaluated the effect of a community capacity-building approach on PLHWUD's access to healthcare services. METHODS A cluster randomized controlled trial was conducted in four provinces of Vietnam. Trained commune health workers in the intervention condition were encouraged to provide services to PLHWUD in the community and engage them in HIV/addiction treatment and care using learned knowledge and skills. A total of 241 PLHWUD participated in surveys at the baseline and every three months for one year. The primary outcome was PLHWUD's reported barriers to seeking healthcare. A linear mixed-effects regression model with a difference in difference approach was used to estimate the intervention effect on the primary outcome. RESULTS Adjusted analyses indicated that significant intervention effects were observed at the Sixth and ninth month follow-ups for those on ART at the baseline and increased motivation to engage in treatment at the 3-month follow-up (60.2% vs 34.4% for the intervention and control groups, respectively). CONCLUSIONS The community capacity-building intervention had shown promising yet limited outcomes among a subset of PLHWUD in the community, that is, PLHWUD who had already initiated ART.
Collapse
Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior – Center for Community Health, University of California, Los Angeles, CA, USA
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior – Center for Community Health, University of California, Los Angeles, CA, USA
| | - Li-Jung Liang
- Semel Institute for Neuroscience and Human Behavior – Center for Community Health, University of California, Los Angeles, CA, USA
| | - Weilu Song
- Semel Institute for Neuroscience and Human Behavior – Center for Community Health, University of California, Los Angeles, CA, USA
| | - Loc Quang Pham
- Semel Institute for Neuroscience and Human Behavior – Center for Community Health, University of California, Los Angeles, CA, USA
| | - Tuan Anh Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| |
Collapse
|
4
|
Lifson AR, Workneh S, Hailemichael A, MacLehose RF, Horvath KJ, Hilk R, Sites A, Shenie T. Disclosure of HIV status among patients new to HIV care in Southern Ethiopia: role of perceived social support and other factors. AIDS Care 2020; 33:1133-1138. [PMID: 32613851 DOI: 10.1080/09540121.2020.1785999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Reports from Sub-Saharan Africa, with a large HIV-infected population, vary widely in how often HIV status is disclosed to others, including spouses and other partners. We surveyed 1799 Ethiopian HIV patients newly enrolled in care within the previous 3 months at one of 32 local hospitals and health centers about disclosure of HIV status and two perceived social support domains: emotional/informational (EI) and tangible assistance (TA) support. Disclosure to another person was reported by 1389 (77%) persons. Disclosure rates to specific persons were: spouses or other partners = 74%; mothers = 24%; fathers = 16%; children = 26%; other family members = 37%; friends = 19%, and neighbors/other community members = 13%. Disclosure to another person was associated with higher social support scores on both EI and TA domains, marriage, and a longer time knowing HIV status. In multivariate adjusted models, disclosure to any person, as well as disclosure specifically to a spouse or partner, were associated with higher EI and higher TA social support scores. Provision of knowledgeable and emotionally supportive assistance can be an important factor in facilitating HIV disclosure. Helping persons with HIV decide who to disclose to and how to do so in the most positive manner is an essential component of HIV care and support.
Collapse
Affiliation(s)
- Alan R Lifson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Sale Workneh
- National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
| | - Abera Hailemichael
- National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Keith J Horvath
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Rose Hilk
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Anne Sites
- National Alliance of State and Territorial AIDS Directors, Global Program, Washington DC, USA
| | - Tibebe Shenie
- National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
| |
Collapse
|
5
|
Lifson AR, Workneh S, Hailemichael A, MacLehose RF, Horvath KJ, Hilk R, Sites AR, Shenie T. Advanced HIV Disease among Males and Females Initiating HIV Care in Rural Ethiopia. J Int Assoc Provid AIDS Care 2020; 18:2325958219847199. [PMID: 31104543 PMCID: PMC6748532 DOI: 10.1177/2325958219847199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Despite recommendations for rapidly initiating HIV treatment, many persons in sub-Saharan
Africa present to care with advanced HIV disease. Baseline survey and clinical data were
collected on 1799 adults newly enrolling at 32 district hospitals and local health HIV
clinics in rural Ethiopia. Among those with complete HIV disease information, advanced HIV
disease (defined as CD4 count <200 cells/mm3 or World Health Organization
[WHO] HIV clinical stage III or IV disease) was present in 66% of males and 56% of females
(P < .001). Males (compared to females) had lower CD4 counts (287
cells/mm3 versus 345 cells/mm3), lower body mass index (19.3
kg/m2 versus 20.2 kg/m2), and more WHO stage III or IV disease
(46% versus 37%), (P < .001). Men reported more chronic diarrhea,
fevers, cough, pain, fatigue, and weight loss (P < .05). Most
initiating care in this resource-limited setting had advanced HIV disease. Men had poorer
health status, supporting the importance of earlier diagnosis, linkage to care, and
initiation of antiretroviral therapy.
Collapse
Affiliation(s)
- Alan Raymond Lifson
- 1 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Sale Workneh
- 2 National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
| | - Abera Hailemichael
- 2 National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
| | | | - Keith Joseph Horvath
- 1 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Rose Hilk
- 1 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Anne Redmond Sites
- 3 National Alliance of State and Territorial AIDS Directors, Global Program, Washington, DC, USA
| | - Tibebe Shenie
- 2 National Alliance of State and Territorial AIDS Directors, Ethiopian Office, Addis Ababa, Ethiopia
| |
Collapse
|