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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Peer health workers and AIDS care in rakai, Uganda: A mixed methods operations research evaluation of a cluster-randomized trial
AIDS Patient Care and STDs, Volume 25, No. 12, Year 2011
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Description
Settings with limited health care workers are challenging environments for delivery of antiretroviral therapy. One strategy to address this human resource crisis is to task shift through training selected patients as peer health workers (PHWs) to provide care to other individuals receiving antiretroviral therapy. To better understand processes of a cluster-randomized trial on the effect of these PHWs on AIDS care, we conducted a mixed methods operations research evaluation. Qualitative methods involved patients, PHWs, and clinic staff and included 38 in-depth interviews, 8 focus group discussions, and 11 direct observations. Quantitative methods included staff surveys, process, and virologic data analyses. Results showed that task shifting to PHWs positively affected structural and programmatic functions of care delivery-improving clinical organization, medical care access, and patient-provider communication-with little evidence for problems with confidentiality and inadvertent disclosure. Additionally, this evaluation elucidated trial processes including evidence for direct and indirect control arm contamination and evidence for mitigation of antiretroviral treatment fatigue by PHWs. Our results support the use of PHWs to complement conventional clinical staff in delivering AIDS care in low-resource settings and highlight how mixed methods operations research evaluations can provide important insights into community-based trials. © Mary Ann Liebert, Inc.
Authors & Co-Authors
Arem, Hannah
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Nakyanjo, Neema
Uganda, Kalisizo
Rakai Health Sciences Program
Kagaayi, Joseph
Uganda, Kalisizo
Rakai Health Sciences Program
Mulamba, Jeremiah
Uganda, Kalisizo
Rakai Health Sciences Program
Nakigozi, Gertrude F.
Uganda, Kalisizo
Rakai Health Sciences Program
Serwadda, David Musoke
Uganda, Kalisizo
Rakai Health Sciences Program
Quinn, Thomas Charles
United States, Baltimore
Johns Hopkins School of Medicine
United States, Bethesda
National Institutes of Health Nih
Gray, Ronald H.
United States, Baltimore
Johns Hopkins Bloomberg School of Public Health
Bollinger, Robert Cyril
United States, Baltimore
Johns Hopkins School of Medicine
Reynolds, Steven James
United States, Baltimore
Johns Hopkins School of Medicine
United States, Bethesda
National Institutes of Health Nih
Chang, Larry William
United States, Baltimore
Johns Hopkins School of Medicine
Statistics
Citations: 50
Authors: 11
Affiliations: 4
Identifiers
Doi:
10.1089/apc.2010.0349
ISSN:
10872914
e-ISSN:
15577449
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Study Approach
Qualitative
Quantitative
Mixed-methods
Study Locations
Uganda