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.

KEYWORDS:

• Community health workers
• community home-based care
• antiretroviral treatment
• rural health
• Task shifting
• HIV
• AIDS
• Uganda

Acknowledgements

The authors wish to acknowledge the project staff and research assistants in the Community-Based ARV Project in Fort Portal Uganda, the District Health Officer and District Health Management Team of the Kabarole District, the clinic staff of the Rwimi Health Centre III, Dr Stan Houston from the Department of Medicine at the University of Alberta and Gian Jhangri from the School of Public Health, University of Alberta.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the Canadian Institutes of Health Research (CIHR) [grant number MOP-74586], the International Development Research Centre (IDRC) Doctoral Research Award and the Killam Trusts through their doctoral research award.