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

ABSTRACT

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.

KEYWORDS:

• Community support workers
• HIV retention
• sub-Saharan Africa
• Ethiopia
• rural health

Acknowledgement

Ethiopian study coordinators were Anteneh Mengistu, Behailu Dagne, Engidaw Ayele, Hiwot Tekle, Simret Girma, Signe Tefera, Tesfaye Gemechu, Tsedey Ayele, Tewabe Tamiru, and Yayush Tesfaye. We thank: Lindsey Fabian and Madelyn Tillemans from the University of Minnesota; and the Southern Nations, Nationalities, and Peoples’ Region Regional Health Bureau. Additional details on the study protocol are available from Dr. Lifson. We especially thank all people living with HIV for their generous participation in this study. All participants provided signed informed consent after verbal explanation of consent provisions. Ethiopia's Ministry of Science and Technology National Research Ethics Committee and the University of Minnesota Institutional Review Board approved this study. Funding was provided by the National Institute of Mental Health, NIH, grant: 5R01MH105290.

Disclosure statement

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

Additional information

Funding

Funding was provided by the National Institute of Mental Health, NIH, grant: 5R01MH105290.