title: Implementation of a Peer HIV Community Support Worker Program in Rural Ethiopia to Promote Retention in Care.
abstract: Retention in care is a major challenge for HIV treatment programs, including in rural and in resource-limited settings. To help reduce loss to follow-up (LTFU) for HIV-infected patients new to care in rural Ethiopia, 142 patients were assigned 1 of 13 trained community health support workers (CHSWs) who were HIV positive and from the same neighborhood/village. The CHSWs provided HIV and health education, counseling/social support, and facilitated communication with the HIV clinics. With 7 deaths and 3 transfers, the 12-month retention rate was 94% (95% CI = 89%-97%), and no client was LTFU in the project. Between enrollment and 12 months, clients had significant ( P ≤ .001) improvements in HIV knowledge (17% increase), physical and mental quality of life (81% and 21% increase), internalized stigma (97% decrease), and perceived social support (24% increase). In rural and resource-limited settings, community-based CHSW programs can complement facility-based care in reducing LTFU and improving positive outcomes for HIV-infected people who enter care.
authors.affiliation: 1 Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Lifson
authors.affiliation: 2 Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia.
authors.forename: Sale
authors.initials: S
authors.lastname: Workneh
authors.affiliation: 2 Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia.
authors.forename: Abera
authors.initials: A
authors.lastname: Hailemichael
authors.affiliation: 2 Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia.
authors.forename: Workneh
authors.initials: W
authors.lastname: Demisse
authors.affiliation: 3 Global Program, National Alliance of State and Territorial AIDS Directors, Washington, DC USA.
authors.forename: Lucy
authors.initials: L
authors.lastname: Slater
authors.affiliation: 2 Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia.
authors.forename: Tibebe
authors.initials: T
authors.lastname: Shenie
mesh_terms: D000328:Adult; D000368:Aged; D003150:Community Health Workers; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D010379:Peer Group; D012423:Rural Health; D012424:Rural Population / Q000706:statistics & numerical data; D012944:Social Support; D055815:Young Adult
keywords: HIV; community health workers; retention in care; rural health; social support