Peer Health Workers and AIDS Care in Rakai, Uganda: A Mixed Methods Operations Research Evaluation of a Cluster-Randomized Trial

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
AIDS patient care and STDs (Impact Factor: 3.5). 03/2011; 25(12):719-24. DOI: 10.1089/apc.2010.0349
Source: PubMed


Settings with limited health care workers are challenging environments for delivery of antiretroviral therapy. One strategy to address this human resource crisis is to task shift through training selected patients as peer health workers (PHWs) to provide care to other individuals receiving antiretroviral therapy. To better understand processes of a cluster-randomized trial on the effect of these PHWs on AIDS care, we conducted a mixed methods operations research evaluation. Qualitative methods involved patients, PHWs, and clinic staff and included 38 in-depth interviews, 8 focus group discussions, and 11 direct observations. Quantitative methods included staff surveys, process, and virologic data analyses. Results showed that task shifting to PHWs positively affected structural and programmatic functions of care delivery--improving clinical organization, medical care access, and patient-provider communication--with little evidence for problems with confidentiality and inadvertent disclosure. Additionally, this evaluation elucidated trial processes including evidence for direct and indirect control arm contamination and evidence for mitigation of antiretroviral treatment fatigue by PHWs. Our results support the use of PHWs to complement conventional clinical staff in delivering AIDS care in low-resource settings and highlight how mixed methods operations research evaluations can provide important insights into community-based trials.


Available from: Joseph Kagaayi, Mar 05, 2015
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    • "ill burden " ; " loss of desire to take medication over time due to high pill burden " Saitoh et al . ( 2008 ) " patients who were unable to take antiretroviral medications because of pill burden and / or nonadherence " Regimen fatigue Marhefka et al . ( 2006 ) No definition provided Merzel et al . ( 2008 ) No definition provided Treatment fatigue Arem et al . ( 2011 ) " patients tiring of continually taking ART " Bagenda et al . ( 2011 ) No definition provided Di Mascio et al . ( 2003 ) No definition provided Fox et al . ( 2010 ) No definition provided McMahon et al . ( 2001 ) No definition provided Miramontes ( 2001 ) " treatment fatigue is a generic term that includes aspects from all three domai"
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    Psychology Health and Medicine 08/2014; 20(3):1-11. DOI:10.1080/13548506.2014.945601 · 1.26 Impact Factor
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    • "However, for home-based interventions to be successfully rolled out in an African setting, there would still be need for long-term management of HIV patients using culturally acceptable approaches that promote adherence to ART; that can also be easily integrated into public health models of ART care [42]. As demonstrated by Chang and colleagues in 2009 and 2010 [38,43] and recently by Arem and colleagues in 2011 [40], this can be achieved through training of HIV patients (nominated by fellow patients) to provide HIV care in homes. Consequently, this may provide long-term benefits of adherence to ART and retention in care [37]. "
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    BMC Public Health 03/2014; 14(1):239. DOI:10.1186/1471-2458-14-239 · 2.26 Impact Factor
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    • "Increasingly researchers are arguing for a comprehensive package of treatment, care and prevention of onward transmission, implemented at the local level, as the most effective way to deal with the current and long-term needs of HIV patients. In spite of limited research in the form of randomized control trials, there is growing evidence that community-based programs can play an important role in improving treatment and health outcomes [18]-[24]. "

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