A three-year randomized community trial of community support workers in rural Ethiopia to promote retention in HIV care

Bibliographic Data

ID19441473
AuthorsAlan R Lifson (0000-0002-1962-1830, University of Minnesota, corresponding author), Abera Hailemichael (Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia), Sale Workneh (Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia), Richard F Maclehose (0000-0003-2041-3710, University of Minnesota), Keith J Horvath (0000-0001-7569-2839, University of Minnesota), Rose Hilk (University of Minnesota), Anne Sites (National Alliance of State and Territorial AIDS Directors), Lucy Slater (National Alliance of State and Territorial AIDS Directors), Tibebe Shenie (Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia)
Year2022
Volume34
Issue12
Pages1506-1512
Publication date2022-12-02
Open AccessNo
TypeARTICLE
VenueAIDS Care (JOURNAL)
Journal identifiersISSN: 0954-0121 • E-ISSN: 1360-0451
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/09540121.2022.2029819
PMID35195481
OpenAlexW4212875694
LanguageEN
Citations received2
References cited22

Retention in care is a major challenge for global AIDS control, including sub-Saharan Africa. In a large Ethiopian region, we evaluated an intervention where HIV positive community support workers (CSWs) provided HIV health education, personal counseling and social support for HIV patients new to care. We enrolled 1,799 patients recently entering care from 32 hospitals and health centers, randomized to intervention or control sites. Dates of all clinic visits, plus deaths or transfers were abstracted from HIV medical records. Primary outcomes were gap in clinical care (>90 days from a missed clinical or drug pickup appointment) and death. For 36 months of follow-up, and for the first 12 months after enrollment, weighted risk differences [RD] between treatment arms were modest and non-significant for gap in clinical care, death or either outcome. Through 36 months, 624 of 980 controls and 469 of 819 intervention participants had gaps in clinical care (RD = -5.5%, 95% confidence interval [CI] = -17.9%, 7.0%); 79 controls and 82 intervention participants died (RD = 2.5% 95% CI = -1.7%, 6.8%). Factors including HIV stigma and a volatile political climate may have attenuated the advantages we anticipated, demonstrating how benefits of CSW interventions may depend upon psychosocial, clinical and structural factors particular to specific community settings

Clinical trial · Confidence interval · Family medicine · Health care · Medical record · Psychiatry · Psychological intervention · Psychosocial · Randomized controlled trial · Adolescent Sexual and Reproductive Health · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Nursing · Internal Medicine

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