Viljoen Lario, Mainga Tila, Casper Rozanne, Mubekapi-Musadaidzwa Constance, Wademan Dillon T, Bond Virginia A, Pliakas Triantafyllos, Bwalya Chiti, Stangl Anne, Phiri Mwelwa, Yang Blia, Shanaube Kwame, Bock Peter, Fidler Sarah, Hayes Richard, Ayles Helen, Hargreaves James R, Hoddinott Graeme, Seeley J, Donnell D, Floyd S, Mandla N, Bwalya J, Sabapathy K, Eshleman S H, Macleod D, Moore A, Vermund S H, Hauck K, Shanaube K
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Desmond Tutu TB Centre, Stellenbosch University, Lower Level Clinical Building, Francie van Zijl Drive, Cape Town 7505, South Africa.
Department of Sociology and Social Anthropology, Stellenbosch University, Stellenbosch, South Africa.
Health Policy Plan. 2021 Jun 25;36(6):881-890. doi: 10.1093/heapol/czab019.
The global expansion of HIV testing, prevention and treatment services is necessary to achieve HIV epidemic control and promote individual and population health benefits for people living with HIV (PLHIV) in sub-Saharan Africa. Community-based health workers (CHWs) could play a key role in supporting implementation at scale. In the HPTN 071 (PopART) trial in Zambia and South Africa, a cadre of 737 study-specific CHWs, working closely with government-employed CHW, were deployed to deliver a 'universal' door-to-door HIV prevention package, including an annual offer of HIV testing and referral services for all households in 14 study communities. We conducted a process evaluation using qualitative and quantitative data collected during the trial (2013-2018) to document the implementation of the CHW intervention in practice. We focused on the recruitment, retention, training and support of CHWs, as they delivered study-specific services. We then used these descriptions to: (i) analyse the fidelity to design of the delivery of the intervention package, and (ii) suggest key insights for the transferability of the intervention to other settings. The data included baseline quantitative data collected with the study-specific CHWs (2014-2018); and qualitative data from key informant interviews with study management (n = 91), observations of CHW training events (n = 12) and annual observations of and group discussions (GD) with intervention staff (n = 68). We show that it was feasible for newly recruited CHWs to implement the PopART intervention with good fidelity, supporting the interpretation of the trial outcome findings. This was despite some challenges in managing service quality and CHW retention in the early years of the programme. We suggest that by prioritizing the adoption of key elements of the in-home HIV services delivery intervention model-including training, emotional support to workers, monitoring and appropriate remuneration for CHWs-these services could be successfully transferred to new settings.
扩大全球艾滋病毒检测、预防和治疗服务对于实现艾滋病毒疫情控制以及促进撒哈拉以南非洲艾滋病毒感染者（PLHIV）的个人和群体健康益处而言至关重要。社区卫生工作者（CHW）在支持大规模实施方面可发挥关键作用。在赞比亚和南非开展的HPTN 071（PopART）试验中，部署了737名针对该研究的社区卫生工作者，他们与政府雇佣的社区卫生工作者密切合作，提供“通用”的挨家挨户艾滋病毒预防套餐，包括每年为14个研究社区的所有家庭提供艾滋病毒检测及转诊服务。我们利用试验期间（2013 - 2018年）收集的定性和定量数据进行了过程评估，以记录社区卫生工作者干预措施在实际中的实施情况。我们关注社区卫生工作者在提供针对该研究的服务时的招募、留用、培训和支持情况。然后，我们利用这些描述来：（i）分析干预套餐交付对设计的忠实度，以及（ii）为将干预措施转移到其他环境提出关键见解。数据包括与针对该研究的社区卫生工作者收集的基线定量数据（2014 - 2018年）；以及来自与研究管理人员进行的关键信息访谈（n = 91）、社区卫生工作者培训活动观察（n = 12）以及与干预工作人员进行的年度观察和小组讨论（GD）（n = 68）的定性数据。我们表明，新招募的社区卫生工作者以较高的忠实度实施PopART干预措施是可行的，这支持了对试验结果的解读。尽管在该项目早期的服务质量管理和社区卫生工作者留用方面存在一些挑战。我们建议，通过优先采用家庭艾滋病毒服务交付干预模式的关键要素，包括培训、对工作人员的情感支持、监测以及为社区卫生工作者提供适当报酬，这些服务可以成功转移到新的环境中。
