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The effectiveness of a volunteer community health worker program to support an antiretroviral treatment program for AIDS patients in western Uganda Open Access


Other title
Community Health Worker
Type of item
Degree grantor
University of Alberta
Author or creator
Alibhai, Arif A
Supervisor and department
Kipp, Walter (Public Health Sciences)
Examining committee member and department
Saunders, L Duncan (Public Health Sciences)
Mill, Judith (Nursing)
Menon, Devidas (Public Health Sciences)
MacDonald, Wendy (Grant MacEwan University)
School of Public Health Sciences

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Background: A research team from the University of Alberta and Uganda established a community based antiretroviral treatment (ART) program for AIDS patients in rural western Uganda. This program engaged laypersons as volunteer community health workers (CHWs) to support ART activities. Research Questions: This study examined whether CHWs could effectively perform a range of activities to support ART, how the elements of a volunteer CHW program functioned, and what patients, health workers and CHWs felt were the benefits to patients of using volunteer CHWs. Methods: This was a mixed methods study. Between 2006 and 2008, cross-sectional and longitudinal data were obtained from CHW surveys and focus groups, health worker focus groups, patient interviews, clinic charts, and program documents. Results: CHWs were able to effectively deliver drugs, monitor adherence to ART, and promote behaviour change and condoms for the prevention of HIV transmission. However, findings pointed to concerns regarding the ability of CHWs to identify side-effects of ART. After two years, 65.7% of patients achieved virologic suppression and 16.9% died. In multivariate analyses, having to travel one or more hours to the patient, compared to less than one hour, was the only statistically significant CHW characteristic that predicted virologic failure (adjusted OR = 0.29, p = 0.002) and mortality (adjusted HR = 4.52, p = 0.026). Patients and health workers attributed positive ART outcomes to the role of the CHWs in reducing the transport burden and wait times for patients. Patients valued the emotional and compassionate support to patients. The biggest challenges for CHWs were distances they had to travel, patient stigma, patient social issues, and community misperceptions about the CHW role. Some issues resolved with time and experience. Despite these challenges, the attrition rate for CHWs was only 2.4% over the two year period. CHWs felt highly motivated by the recognition and appreciation of the community and the opportunity to help reduce mortality within their community. Conclusions: The CHW program contributed to positive treatment outcomes for rural AIDS patients and provides recommendations for replication of this program to other areas of sub-Saharan Africa.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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