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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

基本信息

批准号：
9033951
负责人：
ALAN R LIFSON
金额：
$ 53.83万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
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/9033951
关键词：
Accounting Address Africa South of the Sahara African Aftercare Area Attitude Behavior Body mass index Buffers CD4 Lymphocyte Count Caring Chronic Disease Client Clinic Clinic Visits Clinical Communities Community Trial Continuity of Patient Care Counseling Cox Proportional Hazards Models Data Education Emotional Enrollment Ethiopia Ethiopian 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 persistent symptom physical conditioning programs randomized trial social stigma standard of care stressor

项目摘要

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.