Novel community health worker strategy for HIV service engagement in a hyperendemic community in Rakai, Uganda: A pragmatic, cluster-randomized trial

by Larry W. Chang, Ismail Mbabali, Heidi Hutton, K. Rivet Amico, Xiangrong Kong, Jeremiah Mulamba, Aggrey Anok, Joseph Ssekasanvu, Amanda Long, Alvin G. Thomas, Kristin Thomas, Eva Bugos, Rose Pollard, Kimiko van Wickle, Caitlin E. Kennedy, Fred Nalugoda, David Serwadda, Robert C. Bollinger, Thomas C. Quinn, Steven J. Reynolds, Ronald H. Gray, Maria J. Wawer, Gertrude Nakigozi BackgroundEffective implementation strategies are needed to increase engagement in HIV services in hyperendemic settings. We conducted a pragmatic cluster-randomized trial in a high-risk, highly mobile fishing community (HIV prevalence: approximately 38%) in Rakai, Uganda, to assess the impact of a community health worker-delivered, theory-based (situated Information, Motivation, and Behavior Skills), motivational interviewing-informed, and mobile phone application-supported counseling strategy called “Health Scouts” to promote engagement in HIV treatment and prevention services. Methods and findingsThe study community was divided into 40 contiguous, randomly allocated clusters (20 intervention clusters,n = 1,054 participants at baseline; 20 control clusters,n = 1,094 participants at baseline). From September 2015 to December 2018, the Health Scouts were deployed in intervention clusters. Community-wide, cross-sectional surveys of consenting 15 to 49-year-old residents were conducted at approximately 15 months (mid-study) and at approximately 39 months (end-study) assessing the primary programmatic ...
Source: PLoS Medicine - Category: Internal Medicine Authors: Source Type: research