Peer Health Workers and AIDS Care in Rakai, Uganda: A Mixed Methods Operations Research Evaluation of a Cluster-Randomized Trial
Peer Health Workers and AIDS Care in Rakai, Uganda: A Mixed Methods Operations Research Evaluation of a Cluster-Randomized Trial
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DOI：
10.1089/apc.2010.0349
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发表时间：
2011-12-01
影响因子：
4.9
通讯作者：
Chang, Larry W.
中科院分区：
文献类型：
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作者：
Arem, Hannah;Nakyanjo, Neema;Chang, Larry W.
卫生保健工作者有限的环境对提供抗逆转录病毒疗法具有挑战性。解决这一人力资源危机的一项战略是通过培训选定的病人作为同伴保健工作者，向其他接受抗逆转录病毒治疗的人提供护理，从而转移任务。为了更好地了解这些PHW对艾滋病护理效果的整群随机试验过程，我们进行了混合方法的运筹学评估。定性方法涉及患者，PHW和诊所工作人员，包括38次深入访谈，8次焦点小组讨论和11次直接观察。定量方法包括工作人员调查、过程和病毒学数据分析。结果表明，任务转移到PHWs积极影响的结构和程序功能的护理交付，改善临床组织，医疗服务的访问，和病人与供应商的沟通，几乎没有证据的保密性和无意中披露的问题。此外，该评价阐明了试验过程，包括直接和间接对照组污染的证据以及PHW减轻抗逆转录病毒治疗疲劳的证据。我们的结果支持使用PHW来补充传统临床工作人员在资源匮乏的环境中提供艾滋病护理，并强调混合方法运筹学评估如何为基于社区的试验提供重要见解。
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.