Assessing the Influence of Community Health Worker Support on Early Antiretroviral Therapy Adherence, Anticipated Stigma, and Mental Health Among People Living with HIV in Tanzania

Abstract

In many low-and middle-income countries, community health workers (CHWs) support multiple aspects of HIV care, including patient education and counseling, adherence support, and re-engaging patients lost to care. In Tanzania, the Community-Based HIV Services program is a nationwide cohort of CHWs supporting HIV care engagement. We enrolled a prospective cohort study of 80 people initiating HIV care at two Tanzanian clinics and conducted baseline and 3-month follow-up assessments to examine the potential influence of CHW support and other factors on patient early self-reported medication adherence, depression, anxiety, attitudes about medication, and HIV stigma. The vast majority of participants reported maintaining strong antiretroviral therapy (ART) adherence during the study and endorsed beliefs that ART is beneficial for them. However, there was high occurrence of likely depression and anxiety disorders in the study sample. Patient contact with CHWs at the clinic was unexpectedly low; fewer than two-thirds of participants were informed about the CHW program and fewer than one-third ever met with a CHW. Among participants who met with a CHW, there was mixed feedback about the helpfulness of the program, and contact with a CHW did not improve medication adherence at 3-month follow-up. Male participants, those with likely depression, and those who lived further from the clinic were significantly more likely to experience adherence challenges. The study findings indicate that CHWs are currently underutilized to provide patient support and may not be producing observable benefits to patients in this setting, representing a missed opportunity to address patient challenges, including depression and anxiety.

Acceptability of Home-Based HIV Care Offered by Community Health Workers in Tshwane District, South Africa: A Survey

“…In a study done in Tanzania, there were mixed feedback about helpfulness of community-based HIV services offered by CHWs. 22 One of the most important findings of our study is that >95% of participants thought that home-based HIV care is a good initiative that will help them. This demonstrates that there is significant support for this intervention, but that specific issues need to be addressed to make the intervention acceptable to all.…”

Roles, Barriers, and Recommendations for Community Health Workers Providing Community-Based HIV Care in Sub-Saharan Africa: A Review

“… 48 , 49 However, some authors feel that CHWs are currently underutilized in providing patient support and may not be producing observable benefits. 50 This systematic, aggregated, narrative review on the roles, barriers, and recommendations for CHWs with regard to community-based HIV care support this view but also found that barriers and challenges remain that have to be addressed for patients and households to derive the maximum benefit from such services.…”

“…Significant effort should be made to address the lack of oversight, structured support for challenging cases, and incentives to promote a high quality of home-based HIV services. 50 …”

Prevalence, Patterns and Predictors of Status Disclosure amongst HIV Clients Accessing Care in a Tertiary Health Facility in Nigeria

“…Some of the potential benefits of disclosure were improving emotional and psychological wellbeing, early enrolment on antiretroviral therapy, and better adherence to therapy [11,12]. Disclosure to a sexual partner may increase HIV testing and reduce the risk of HIV transmission [13]. Including HIV transmission from the mother to child [13,14].…”

“…Disclosure to a sexual partner may increase HIV testing and reduce the risk of HIV transmission [13]. Including HIV transmission from the mother to child [13,14]. The disclosure of an HIV status to a sexual partner can have varying effects.…”