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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

  • Author / Creator
    Alibhai, Arif A
  • 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.

  • Subjects / Keywords
  • Graduation date
    2013-11
  • Type of Item
    Thesis
  • Degree
    Doctor of Philosophy
  • DOI
    https://doi.org/10.7939/R39S1KT6N
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
    English
  • Institution
    University of Alberta
  • Degree level
    Doctoral
  • Department
    • School of Public Health Sciences
  • Supervisor / co-supervisor and their department(s)
    • Kipp, Walter (Public Health Sciences)
  • Examining committee members and their departments
    • Saunders, L Duncan (Public Health Sciences)
    • Menon, Devidas (Public Health Sciences)
    • MacDonald, Wendy (Grant MacEwan University)
    • Mill, Judith (Nursing)