The Role of Community Health Workers in HIV Care Engagement: A Qualitative Study of Stakeholder Perspectives in Tanzania

Abstract

Suboptimal retention in HIV care is a major driver of the global epidemic, including in sub-Saharan Africa. In Tanzania, the national Community-Based HIV Services program integrates volunteer community health workers (CHWs) to support patient care engagement and reduce the burden placed on HIV clinic nurses; however, few studies have assessed the value of CHWs supporting HIV care. Qualitative interviews were conducted with 48 administrators, nurses, CHWs, and patients to explore strengths and limitations of the Community-Based HIV Services program. Stakeholders believed CHWs are uniquely positioned to establish trust and provide patient support. Patients who had frequent contact with CHWs described them as valued sources of education and encouragement, but fewer than half of the patients interviewed had ever met with a CHW. Clinic nurses described feeling disconnected from CHWs, and stakeholders highlighted the need for financial, logistical, and educational support to rejuvenate the program and effectively address care engagement challenges.

Perspectives of health workers engaging in task shifting to deliver health care in low-and-middle-income countries: a qualitative evidence synthesis

“…The total number of participants from all stakeholder groups across all 54 included studies were between 2394 and 2482. Forty two studies were from sub-Saharan Africa [ 19 , 32–71 ], four from South Asia [ 72–75 ], three from South East Asia [ 18 , 76 , 77 ], one from Central Asia [ 78 ] and four were multi-LMIC studies [ 79–82 ].…”

“…Capability of HWs is an important prerequisite for implementation and successful delivery of task shifting. Barriers and facilitators to engaging HWs in task shifting have been explored broadly through individual studies from the perspective of a range of stakeholders including policy makers, healthcare managers, patients, and community representatives and different HW cadres [ 18 , 19 ]. However, there is a gap in in-depth knowledge about HWs perspectives of what motivates them to engage in task shifting and what challenges and facilitators they encounter when doing so.…”

A community health worker delivered intervention to address hypertension among adults engaged in HIV care in northern Tanzania: Outcomes from a pilot feasibility study

“…Our CHW delivered the intervention with close to 100% fidelity, and participants in our study reported appreciation of the CHW and satisfaction with the content delivered. Prior studies in Tanzania have shown that HIV care delivery by CHWs is favorably received 34,35 . Furthermore, a few studies have also revealed that interventions offering NCD care delivered by CHWs are feasible, highly acceptable, and effective 36,37 .…”

“…Prior studies in Tanzania have shown that HIV care delivery by CHWs is favorably received. 34,35 Furthermore, a few studies have also revealed that interventions offering NCD care delivered by CHWs are feasible, highly acceptable, and effective. 36,37 The utilization of CHWs to provide care may be an attractive strategy in a health care system that is overtaxed by high patient volumes and few prescribing providers.…”

Stigma and Discrimination of HIV/AIDs Recipients of Care in Western Uganda: Experiences and Roles of Expert Clients

“…In other studies, it was reported that many different barriers to community-based HIV care were reported and they were stigma and nondisclosure; inadequate support (lack of resources, inadequate training, inadequate funding, and inadequate monitoring). 12,28 This greatly hindered the work of the expert clients. Significant efforts should be made to mitigate these barriers by addressing HIV-…”