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An RCT to Improve the South African Government's Community Health Workers' Capacities to Deliver Evidence-based Interventions for Optimizing HIV Outcomes and Reducing its Comorbidities

一项旨在提高南非政府社区卫生工作者提供循证干预措施以优化艾滋病毒治疗结果并减少其合并症的能力的随机对照试验

基本信息

批准号：
9978918
负责人：
Mary Jane Rotheram-Borus
金额：
$ 53.95万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-09 至 2023-07-31
项目状态：
已结题

项目摘要

Abstract Health services and especially community-based health services in Africa are characterized by inefficiency, limited capacity, and poorly-trained personnel. The quality of care in these systems is dependent most heavily on personnel: training, monitoring, and ongoing quality of the implementation. South Africa is deploying 65,000 community health workers (CHW), however, there are almost no systems currently, nor are the systems yet planned for how to train, monitor, and ensure quality care is delivered by these CHW. In a pilot over the last six months in the Eastern Cape of South Africa, we found 25% of CHW not showing up for work at any time, when supervision was out-sourced for the first time. Such performance and failures to monitor performance, with consequences of censuring non-attendance, are often typical of CHW service delivery in low and middle income countries (LMIC). Building on the results of a successful effectiveness study in the townships of Cape Town, South Africa, we aim to show that training, monitoring, and data-informed supervision will result in CHW having significant benefits in maternal and child health (MCH) over the first two years of life, particularly mothers living with HIV, depressed mothers, and teenage mothers. With support from the provincial government, Philani's innovative training and monitoring strategies aim to demonstrate that we can decrease the gap between what we know (based on science) and what we do to improve health in rural communities that currently lack accountability and efficiency. UCLA, Stellenbosch University, Zithulele Hospital, and the Philani Maternal, Child Health and Nutrition Trust will collaborate on this second effectiveness RCT of home visiting delivered by government-funded CHW. UCLA will randomize 24 matched areas, each with government-funded CHW to either: 1) home visiting trained, supervised, and routinely monitored (i.e., the Philani Intervention Model [PIM], n=420 women, 12 areas); or 2) a standard care (SC) control home visiting by CHW who receive current standards of training, monitoring, and supervision (n=420 women, 12 areas). Within the sample, 25% will be adolescent mothers; 30% will be MLH; 25% will drink alcohol in pregnancy; and 22% will be depressed. Independent assessments will be conducted by Stellenbosch University during pregnancy, within two weeks of post-birth, 6, 15, and 24 months later. We will construct an overall analytic test which examines multiple outcomes simultaneously with an omnibus test. We will monitor MLH's HIV testing, linkage to care, treatment adherence and retention; maternal health indicators (weight, diabetes, mental health status, partnerships, alcohol use, and partner violence); and, the child's physical growth, cognitive, affective, and behavioral adjustment. We expect PIM to significantly improve outcomes overall and for the high risk subgroups (MLH, depressed, adolescents, alcohol-using). Analyses of the real-time process measures from CHW (duration, frequency, content area, skill used, phone contacts) collected on mobiles will allow us to design and redesign implementation strategies.

抽象的非洲的卫生服务，特别是社区卫生服务的特点是效率低下、能力有限，人员缺乏训练。这些系统的护理质量在很大程度上取决于关于人员：培训、监控和持续的实施质量。南非正在部署 65,000 名社区卫生工作者 (CHW)，但目前几乎没有系统，也没有尚未规划如何培训、监控和确保这些社区卫生工作者提供优质护理的系统。在飞行员中过去六个月，在南非东开普省，我们发现 25% 的社区卫生工作者没有去上班在监督首次外包的任何时候。此类性能和故障需要监控绩效，以及谴责缺席的后果，通常是社区卫生工作者提供服务的典型特征。低收入和中等收入国家（LMIC）。以一项成功的有效性研究的结果为基础在南非开普敦的乡镇，我们的目标是展示培训、监测和数据知情监督将使 CHW 在孕产妇和儿童健康 (MCH) 方面比前两者获得显着效益生命中的岁月，尤其是感染艾滋病毒的母亲、抑郁的母亲和十几岁的母亲。在来自的支持下菲拉尼的创新培训和监测战略旨在向省政府表明，我们可以缩小我们所知道的（基于科学的）与我们为改善农村健康所做的努力之间的差距目前缺乏问责制和效率的社区。加州大学洛杉矶分校、斯泰伦博斯大学、Zithulele 医院和 Philani 孕产妇、儿童健康和营养信托基金将合作开展由政府资助的 CHW 开展的第二次家访有效性随机对照试验。加州大学洛杉矶分校将随机分配 24 个匹配区域，每个区域都有政府资助的社区卫生工作者：1) 接受过家访培训，监督和定期监测（即菲拉尼干预模型 [PIM]，n=420 名女性，12 个地区）；或 2) 标准护理 (SC) 控制家庭访视，接受当前标准的培训、监测和治疗监督（n=420 名女性，12 个地区）。样本中，25%是青春期母亲； 30% 将是 MLH； 25%的人会在怀孕期间饮酒； 22%的人会感到沮丧。将进行独立评估由斯泰伦博斯大学在怀孕期间、产后两周内、6个月、15个月和24个月后进行。我们将构建一个整体分析测试，通过综合测试同时检查多个结果。我们将监测 MLH 的艾滋病毒检测、与护理的联系、治疗依从性和保留情况；孕产妇保健指标（体重、糖尿病、心理健康状况、伴侣关系、饮酒和伴侣暴力）；并且，孩子的身体成长、认知、情感和行为调整。我们预计 PIM 将显着改善总体结果和高风险亚组（MLH、抑郁症、青少年、酗酒）的结果。分析来自 CHW 的实时流程测量（持续时间、频率、内容领域、使用的技能、电话联系方式）通过手机收集的信息将使我们能够设计和重新设计实施策略。