School of Public Health, University of the Western Cape, Cape Town, South Africa.
Trop Med Int Health. 2012 Apr;17(4):488-96. doi: 10.1111/j.1365-3156.2011.02951.x. Epub 2012 Feb 1.
To describe a participatory approach to implement and evaluate ways to integrate and train community care workers (CCWs) to enhance collaborative TB/HIV/PMTCT activities, and home-based HIV counseling and testing (HCT) at community level.
The intervention study was conducted in Sisonke, a rural district of KwaZulu Natal, South Africa. A baseline household (HH) survey was conducted in 11 villages. Six villages were randomly selected into intervention and control clusters. Training was provided first to CCWs from the intervention cluster (IC) followed by the control cluster (CC). Routine monthly data from CCWs were collected from March-December 2010. The data was subjected to bivariate tests.
The baseline HH survey revealed that of 3012 HH members visited by CCWs in 2008, 21% were screened for TB symptoms, 7% were visited for TB adherence support and 2% for ART adherence, and 1.5% were counselled on infant feeding options. A total of 89 CCWs were trained. Data show that during the study period in IC, 684 adults were offered HCT by CCWs, 92% accepted HCT and tested and 7% tested HIV-positive and were referred to the clinic for further care. Of 3556 adults served in IC, 44% were screened for TB symptoms and 32% for symptoms of sexually transmitted infections (STIs) and 37% of children were traced as TB contact. Out of 6226 adults served in CC, 10% were screened for TB symptoms and 7% for STI symptoms. The differences in uptake of services between IC and CC were statistically significant (p<0.05).
The findings of this study suggest higher uptake of TB and STI symptoms screening, TB contact tracing and home based HCT in the intervention clusters. This study suggests that up-skilling CCWs could be one avenue to enhance TB/HIV case finding, TB contact tracing and linkages to care.
描述一种参与式方法，以实施和评估将社区护理人员（CCW）整合和培训的方式，增强结核病/艾滋病/母婴传播综合防治活动，以及社区一级的家庭艾滋病咨询和检测（HCT）。
干预研究在南非夸祖鲁-纳塔尔省的 Sisonke 农村地区进行。在 11 个村庄进行了基线家庭（HH）调查。随机选择六个村庄进入干预和对照集群。首先对干预集群（IC）的 CCW 进行培训，然后对对照集群（CC）进行培训。2010 年 3 月至 12 月期间，每月从 CCW 收集常规数据。对数据进行了双变量检验。
基线 HH 调查显示，2008 年 CCW 访问的 3012 个 HH 成员中，有 21%接受了结核病症状筛查，7%接受了结核病依从性支持，2%接受了抗逆转录病毒治疗（ART）依从性，1.5%接受了婴儿喂养选择咨询。共有 89 名 CCW 接受了培训。数据显示，在研究期间，IC 共为 684 名成年人提供了 HCT，92%接受了 HCT 并进行了检测，其中 7%检测呈 HIV 阳性，并被转介到诊所接受进一步护理。在服务的 3556 名成年人中，有 44%接受了结核病症状筛查，32%接受了性传播感染（STI）症状筛查，37%的儿童被追踪为结核病接触者。在服务的 6226 名成年人中，有 10%接受了结核病症状筛查，7%接受了 STI 症状筛查。IC 和 CC 之间在服务利用率方面的差异具有统计学意义（p<0.05）。
本研究结果表明，干预集群中结核病和 STI 症状筛查、结核病接触者追踪和家庭 HCT 的利用率更高。本研究表明，提高 CCW 的技能水平可能是增强结核病/艾滋病病例发现、结核病接触者追踪和护理联系的一种途径。
