Article

Task-Shifting to Community Health Workers: Evaluation of the Performance of a Peer-Led Model in an Antiretroviral Program in Uganda

1 Executive Directors Office, Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda.
AIDS patient care and STDs (Impact Factor: 3.5). 02/2012; 26(2):101-7. DOI: 10.1089/apc.2011.0279
Source: PubMed

ABSTRACT

Task shifting to community health workers (CHW) has received recognition. We examined the performance of community antiretroviral therapy and tuberculosis treatment supporters (CATTS) in scaling up antiretroviral therapy (ART) in Reach Out, a community-based ART program in Uganda. Retrospective data on home visits made by CATTS were analyzed to examine the CATTS ability to perform home visits to patients based on the model's standard procedures. Qualitative interviews conducted with 347 randomly selected patients and 47 CATTS explored their satisfaction with the model. The CATTS ability to follow-up with patients worsened from patients requiring daily, weekly, monthly, to three-monthly home visits. Only 26% and 15% of them correctly home visited patients with drug side effects and a missed clinic appointment, respectively. Additionally, 83% visited stable pre-ART and ART patients (96%) more frequently than required. Six hundred eighty of the 3650 (18%) patients were lost to follow-up (LTFU) during the study period. The mean number of patients LTFU per CATTS was 40.5. Male (p = 0.005), worked for longer durations (p = 0.02), and had lower education (p = 0.005). An increased number of patients (p = 0.01) were associated with increased LTFU. Ninety-two percent of the CATTS felt the model could be improved by reducing the workload. CATTS who were HIV positive, female, not residing in the same village as their patients, more educated, married, on ART, and spent less time with the patients were rated better by their patients. The Reach-Out CHW model is labor-intensive. Triaged home visits could improve performance and allow CATTS time to focus on patients requiring more intensive follow-up.

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    • "Performance of CTC providers can be inconsistent. CTC providers working with vertical disease-focused programmes, such as tuberculosis and HIV, with tailored supervision structures often perform better than those with a more integrated long-term approach (Alamo et al. 2012). This tendency for vertical-programme-focused policy has the potential to generate competition for resources and poor coordination among stakeholders and may ultimately undermine policymakers' targets to realize universal health coverage (Victora et al. 2004). "
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    • "Performance of CTC providers can be inconsistent. CTC providers working with vertical disease-focused programmes, such as tuberculosis and HIV, with tailored supervision structures often perform better than those with a more integrated long-term approach (Alamo et al. 2012). This tendency for vertical-programme-focused policy has the potential to generate competition for resources and poor coordination among stakeholders and may ultimately undermine policymakers' targets to realize universal health coverage (Victora et al. 2004). "
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