Assessment of a Community Support Worker Intervention for PLWH in Rural Ethiopia

埃塞俄比亚农村社区支持人员对艾滋病病毒感染者的干预评估

• 批准号: 8845853
• 负责人: ALAN R LIFSON
• 金额: $ 61.99万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-03-12 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8845853
• 关键词: Accounting; Address; Africa South of the Sahara; African; Aftercare; Area; Attitude; Behavior; Body mass index; Buffers; CD4 Lymphocyte Count; Caring; Chronic; Chronic Disease; Client; Clinic; Clinic Visits; Clinical; Communities; Community Trial; Continuity of Patient Care; Counseling; Cox Proportional Hazards Models; Data; Education; Emotional; Enrollment; Ethiopia; Face; Feeling; Future; Goals; HIV; HIV Seropositivity; Health; Health Status; Health Surveys; Hospitals; Immunosuppression; Individual; Intervention; Knowledge; Linear Regressions; Logistic Regressions; Measures; Medical; Mental Health; Methods; Modeling; Nationalities; Newly Diagnosed; Outcome; Patient Education; Patients; Perceived quality of life; Provider; Psyche structure; Quality of life; Randomized; Research; Rural; Services; Site; Social isolation; Social support; Stressful Event; Surveys; Survival Analysis; Symptoms; System; Target Populations; Testing; Time; Training; abstracting; advanced disease; antiretroviral therapy; arm; base; care systems; clinical care; community intervention; community setting; follow-up; group intervention; high risk; improved; instrument; outreach; physical conditioning; programs; public health relevance; randomized trial; social stigma; standard of care; stressor

 DESCRIPTION (provided by applicant): As a critical gap in the HIV cascade of care in sub-Saharan Africa and elsewhere, many patients entering HIV care are lost to follow-up (LTFU), especially within the first 1-2 years. Many such patients die without treatment or return with advanced immune suppression. Our studies in Ethiopia indicate that HIV patients in rural settings (where HIV is increasingly treated) face multiple challenges that may impact retention in care and health status, including lack of knowledge about HIV treatment, internal and perceived stigma, social isolation, and poor access to the medical care system. Although HIV programs have used community support workers (CSWs) to address these and other challenges, evidence for efficacy of CSW programs is largely based on observational and single site studies, and factors associated with positive outcomes are not well understood. During 2011-2012, we successfully implemented a pilot community intervention to support HIV patients in rural Ethiopia, using CSWs who were themselves HIV positive. Among HIV patients newly enrolled in care, LTFU was minimal, and clients had significant improvement in HIV knowledge, mental and physical quality of life, and perceived social support, with reduction in chronic symptoms and internal stigma. Using an intervention grounded in the conceptual framework of social support as buffering against the negative effects of stressful events, we propose to rigorously evaluate a CSW intervention in a large multi-site community randomized trial. In Ethiopia's Southern Nations, Nationalities and Peoples' Region, 8 hospitals and 32 health centers will be randomized to intervention or control arms. For each intervention site, CSWs from that local area will be hired, trained, and assigned to HIV positive clients to provide in community settings: informational support (education/counseling); emotional support (to addressed internal and perceived stigma), companionship support (to reduce social isolation), and instrumental support (with increased access to the HIV clinical care system). 2,640 newly diagnosed HIV patients from these sites will receive a baseline assessment and will be followed for 36 months with yearly follow-up assessments. Health surveys will assess knowledge about HIV treatment, internal and perceived external stigma, feelings of social support, and physical and mental health (quality of life). Data abstracted from the clients' HIV Clinic record will inclue dates of clinic visits (to assess ongoing retention in care), HIV clinical status, CD4+ count and body mass index. We hypothesize that compared to HIV patients in the control arm, those in the intervention arm will have reduced LTFU from HIV clinical care over 36 months of follow-up (Aim 1), as well as increased knowledge, feelings of social support, and health status, and decreased feelings of internal/perceived stigma and social isolation (Aim 2). We will also evaluate the extent to which factors in Aim 2 are predictive of retention in care (Aim 3). This study has strong research implications for future community-based programs using support workers to strengthen the HIV care continuum and to support decentralized HIV care.

 描述（由申请人提供）：作为撒哈拉以南非洲和其他地区艾滋病毒级联治疗的一个关键差距，许多接受艾滋病毒治疗的患者失访（LTFU），特别是在最初的1-2年内。许多这样的患者未经治疗就死亡，或因晚期免疫抑制而复发。我们在埃塞俄比亚的研究表明，农村地区的艾滋病毒患者（艾滋病毒治疗越来越多）面临多重挑战，可能会影响护理和健康状况，包括缺乏艾滋病毒治疗知识，内部和感知的耻辱，社会孤立以及难以获得医疗保健系统。虽然艾滋病毒项目已经使用社区支持工作者（CSW）来解决这些和其他挑战，CSW方案的有效性的证据主要是基于观察和单点研究，并与积极的结果相关的因素没有得到很好的理解。 在2011-2012年期间，我们成功地实施了一项试点社区干预措施，利用本身艾滋病毒呈阳性的性工作者，为埃塞俄比亚农村地区的艾滋病毒患者提供支助。在新登记的艾滋病毒患者的护理，LTFU是最小的，客户有显着改善艾滋病毒知识，精神和身体的生活质量，感知社会支持，减少慢性症状和内部耻辱。 使用基于社会支持的概念框架作为缓冲压力事件的负面影响的干预措施，我们建议在一个大型多站点社区随机试验中严格评估CSW干预。在埃塞俄比亚南部民族和人民地区，8家医院和32个保健中心将被随机分配到干预或控制组。对于每个干预点，将雇用、培训当地的CSW，并将其分配给艾滋病毒阳性的客户，在社区环境中提供：信息支持（教育/咨询）;情感支持（解决内部和感知的耻辱），陪伴支持（减少社会孤立）和工具支持（增加获得艾滋病毒临床护理系统）。来自这些中心的2，640名新诊断的艾滋病毒患者将接受基线评估，并将接受为期36个月的年度随访评估。健康调查将评估有关艾滋病毒治疗的知识、内部和感觉到的外部耻辱、社会支持的感觉以及身心健康（生活质量）。从客户的HIV诊所记录中提取的数据将包括诊所访问日期（以评估持续的护理保留），HIV临床状态，CD 4+计数和体重指数。 我们假设，与对照组的HIV患者相比，干预组患者在36个月的随访中将减少HIV临床护理的LTFU（目标1），以及增加知识，社会支持和健康状况的感觉，以及减少内部/感知耻辱和社会孤立的感觉（目标2）。我们还将评估目标2中的因素在多大程度上预测了护理保留率（目标3）。这项研究具有很强的研究意义，为未来的社区为基础的计划，利用支持工作者，以加强艾滋病毒护理的连续性，并支持分散的艾滋病毒护理。