Healthy People, Healthy Community: Evaluation of a train-the-trainers programme for community health workers on water, sanitation and hygiene in rural Haiti

Yu, Xiaoran; Pendse, Asmita; Slifko, Shay E.; Inman, Arpana G.; Kong, Peggy A.; Knettel, Brandon A.

doi:10.1177/0017896919853850

Cited by 14 publications

(15 citation statements)

References 19 publications

(32 reference statements)

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“…Most LHWs successfully completed the training and achieved high levels of performance, in patient assessment, diagnosis, and treatment criteria. Yu et al [ 33 ] trained LHW supervisors as PTs to provide cascade training to junior LHWs for a water, sanitation, and hygiene program in Haiti. They found a significant increases in PT knowledge and observed ability to provide cascade training; however, knowledge gains were not sustained, with no difference between participants and non-participants 1 year after the intervention; this result suggests the need for refresher training.…”

Section: Discussionmentioning

confidence: 99%

Impact of a tuberculosis treatment adherence intervention versus usual care on treatment completion rates: results of a pragmatic cluster randomized controlled trial

et al. 2020

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Background With the global shortage of skilled health workers estimated at 7.2 million, outpatient tuberculosis (TB) care is commonly task-shifted to lay health workers (LHWs) in many low- and middle-income countries where the shortages are greatest. While shown to improve access to care and some health outcomes including TB treatment outcomes, lack of training and supervision limit the effectiveness of LHW programs. Our objective was to refine and evaluate an intervention designed to address common causes of non-adherence to TB treatment and LHW knowledge and skills training needs. Methods We employed a pragmatic cluster randomized controlled trial. Participants included 103 health centres (HCs) providing TB care in four districts in Malawi, randomized 1:1 stratified by district and HC funding (Ministry of Health, non-Ministry funded). At intervention HCs, a TB treatment adherence intervention was implemented using educational outreach, a point-of-care reminder tool, and a peer support network. Clusters in the control arm provided usual care. The primary outcome was the proportion of patients with successful TB treatment (i.e., cure or treatment completion). We used a generalized linear mixed model, with district as a fixed effect and HC as a random effect, to compare proportions of patients with treatment success, among the trial arms, with adjustment for baseline differences. Results We randomized 51 HCs to the intervention group and 52 HCs to the control group. Four intervention and six control HCs accrued no eligible patients, and 371 of 1169 patients had missing outcome, HC, or demographic data, which left 74 HCs and 798 patients for analysis. Randomization group was not related to missing outcome, however, district, age, and TB type were significantly related and included in the primary analysis model. Among the 1153 patients with HC and demographic data, 297/605 (49%) and 348/548 (64%) in the intervention and control arms, respectively, had treatment success. The intervention had no significant effect on treatment success (adjusted odds ratio 1.35 [95% confidence interval 0.93–1.98]). Conclusion We found no significant effect of the intervention on TB treatment outcomes with high variability in implementation quality, highlighting important challenges to both scale-up and sustainability. Trial registration ClinicalTrials.gov NCT02533089. Registered August 20, 2015.

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Section: Discussionmentioning

confidence: 99%

Impact of a tuberculosis treatment adherence intervention versus usual care on treatment completion rates: results of a pragmatic cluster randomized controlled trial

et al. 2020

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“…The copyright holder for this preprint this version posted November 2, 2022. ; https://doi.org/10.1101/2022.10.26.22281557 doi: medRxiv preprint insecurity dominate day to day life. With inadequate health infrastructure and unaffordable quality healthcare, numerous alternative, community based models designed to build health capacity have been developed and implemented in recent decades [1][2][3][4].…”

Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 99%

“…With this transitional model, sustainability is enhanced as the resource input is diminished, while local community leaders establish the infrastructure needed to develop local health capacity, including training and treatment sites [2][3][4].…”

Section: (Which Was Not Certified By Peer Review)mentioning

confidence: 99%

The Laro Kwo Project: A train the trainer model combined with mobile health technology for Community Health Workers in Northern Uganda

Ebbs

Benson²,

Jasicki³

et al. 2022

Preprint

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Community Health Workers (CHWs) in low and middle income countries (LMICs) provide invaluable health resources to their community members. Best practices for developing and sustaining CHW training programs in LMICs have yet to be defined using rigorous standards and measures of effectiveness. With the expansion of digital health to LMICs, few studies have evaluated the role of participatory methodologies combined with the use of mobile health (mHealth) for CHW training program development. We completed a three-year prospective observational study aligned with the development of a community-based participatory CHW training program in Northern Uganda. Twenty-five CHWs were initially trained using a community participatory training methodology combined with mHealth and a train-the-trainer model. Medical skill competency exams were evaluated after the initial training and annually thereafter to assess retention with use of mHealth. After three years, CHWs who advanced to trainer status redeveloped all program materials using a mHealth application and trained a new cohort of 25 CHWs. Implementation of this methodology coupled with longitudinal mHealth training demonstrated an improvement in medical skills over three years among the original cohort of CHWs. Further, we found that the train-the-trainer model with mHealth was highly effective, as the new cohort of 25 CHWs trained by the original CHWs exhibited higher scores when tested on medical skill competencies. The combination of mHealth and participatory methodologies can facilitate the sustainability of CHW training programs in LMIC. Further investigations should focus on comparing specific mHealth modalities for training and clinical outcomes using similar combined methodologies.

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“…[6][7][8] Although the overall model is promising, there is also literature demonstrating that task-shifting programs often struggle to maintain consistent funding, supervision, and training. [9][10][11] Additionally, Maes 12 and others have highlighted the burden placed on CHWs as they face pressure to support the health of the community, experience financial stress due to the low-paid or volunteer nature of their work, and may lack opportunities for professional advancement. 13 International organizations, such as the World Health Organization, PEPFAR, and UNAIDS, have long recognized the potential of nations in sub-Saharan Africa to implement a sustainable, community-based approach to combating HIV and AIDS.…”

Section: Introductionmentioning

confidence: 99%

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

Knettel

Wanda

Amiri

et al. 2021

AIDS Patient Care and STDs

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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.

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Healthy People, Healthy Community: Evaluation of a train-the-trainers programme for community health workers on water, sanitation and hygiene in rural Haiti

Cited by 14 publications

References 19 publications

Impact of a tuberculosis treatment adherence intervention versus usual care on treatment completion rates: results of a pragmatic cluster randomized controlled trial

Impact of a tuberculosis treatment adherence intervention versus usual care on treatment completion rates: results of a pragmatic cluster randomized controlled trial

The Laro Kwo Project: A train the trainer model combined with mobile health technology for Community Health Workers in Northern Uganda

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

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