Patient perspectives on the helpfulness of a community health worker program for HIV care engagement in Tanzania

ABSTRACT

Task-shifting is a valuable approach for redistributing clinical tasks to nonprofessional health workers and relieving human resource shortages. The Community-Based HIV Services (CBHS) program is a national cohort of volunteer community health workers (CHWs) who support HIV care engagement at clinics in Tanzania. We recruited 23 patients initiating HIV care at two clinics to understand their experiences with the CBHS program. Participants completed qualitative interviews by telephone discussing the perceived helpfulness of the program, their level of connection with CHWs, and suggestions for improvement. Data were analyzed through an inductive, team-based qualitative approach. Most participants found the program to be helpful and described close, positive connections. CHWs offered education, emotional support to accept one’s diagnosis and cope with stigma, and encouragement to remain engaged in HIV care. However, several participants described minimal, shallow contact with CHWs, and felt the program did not benefit their HIV care. Participants recommended increasing CHW efforts to engage people living with HIV (PLWH) in the broader community, and addressing socioeconomic barriers to care engagement. When contacts are consistent, the CBHS program is a strong resource for PLWH. To maximize the potential of the program, administrators should enhance oversight and extend new training opportunities for CHWs.

KEYWORDS:

• Adherence
• antiretroviral therapy (ART)
• community health workers
• community health services
• developing countries
• HIV infections
• low- and middle-income countries (LMICs)
• retention in care
• stigma
• Tanzania
• task-shifting

Acknowledgement

The authors would like to acknowledge Donnalee Frega, Ph.D. of the Duke University School of Nursing for copyediting support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Dr. Knettel was supported by a VECD Fogarty Global Health Fellowship and the NIH Office of Behavioral and Social Sciences Research Science Research (D43 TW009337). We also acknowledge support from the Duke Center for AIDS Research (P30 AI064518) and NIH grants led by Drs. Melissa Watt and Blandina Mmbaga (R21 AI124344; R21 TW011053). An earlier version of this work was presented at the Duke Center for AIDS Research Annual Retreat.