title: Relationship between characteristics of volunteer community health workers and antiretroviral treatment outcomes in a community-based treatment programme in Uganda.
abstract: Community health workers (CHWs) can help to redress the shortages of health human resources needed to scale up antiretroviral treatment (ART). However, the selection of CHWs could influence the effectiveness of a CHW programme. The purpose of this observational study was to assess whether sociodemographic characteristics and geographic proximity to patients of volunteer CHWs were predictors of clinical outcomes in a community-based ART (CBART) programme in Kabarole, Uganda. Data from CHW surveys for 41 CHWs and clinic charts for 185 patients in the CBART programme were analysed using multivariable logistic and Cox regression models. Time to travel to patients was the only statistically significant characteristic of CHWs associated with ART outcomes. Patients whose CHWs had to travel one or more hours had a 71% lower odds of virologic suppression (adjusted OR = 0.29, 95% CI = 0.13-0.65, p = .002) and a 4.52 times higher mortality hazard rate (adjusted HR = 4.52, 95% CI = 1.20-17.09, p = .026) compared to patients whose CHWs had to travel less than one hour. The findings show that the sociodemographic characteristics of CHWs were not as important as the geographic distance they had to travel to patients.
authors.affiliation: a School of Public Health , University of Alberta , Edmonton , Canada.
authors.forename: Arif
authors.initials: A
authors.lastname: Alibhai
authors.affiliation: a School of Public Health , University of Alberta , Edmonton , Canada.
authors.forename: Walter
authors.initials: W
authors.lastname: Kipp
authors.affiliation: a School of Public Health , University of Alberta , Edmonton , Canada.
authors.forename: L Duncan
authors.initials: LD
authors.lastname: Saunders
authors.affiliation: b Community-Based ARV Project , Fort Portal , Uganda.
authors.forename: Tom
authors.initials: T
authors.lastname: Rubaale
authors.affiliation: c Faculty of Nursing , University of Alberta , Edmonton , Canada.
authors.forename: Judy
authors.initials: J
authors.lastname: Mill
authors.affiliation: d School of Public Health , Makerere University , Kampala , Uganda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Konde-Lule
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003153:Community Health Services; D003150:Community Health Workers; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D016896:Treatment Outcome; D014454:Uganda; D014838:Volunteers
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; Community health workers; HIV; Task shifting; Uganda; antiretroviral treatment; community home-based care; rural health