Duke University School of Nursing, Durham, North Carolina, USA.
Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
AIDS Patient Care STDS. 2021 Aug;35(8):308-317. doi: 10.1089/apc.2021.0028.
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.
在许多低收入和中等收入国家，社区卫生工作者（CHWs）支持 HIV 护理的多个方面，包括患者教育和咨询、依从性支持以及重新接触因护理而失去联系的患者。在坦桑尼亚，基于社区的 HIV 服务计划是一个全国性的 CHW 支持 HIV 护理参与的队列。我们招募了一项在坦桑尼亚的两家诊所开始接受 HIV 护理的 80 人前瞻性队列研究，并进行了基线和 3 个月的随访评估，以研究 CHW 支持和其他因素对患者早期自我报告的药物依从性、抑郁、焦虑、对药物的态度和 HIV 耻辱感的潜在影响。绝大多数参与者报告在研究期间保持了强烈的抗逆转录病毒治疗（ART）依从性，并认为 ART 对他们有益。然而，研究样本中出现了很高的可能抑郁和焦虑障碍发生率。患者与诊所 CHW 的接触出乎意料地低；不到三分之二的参与者被告知 CHW 计划，不到三分之一的参与者曾与 CHW 会面。在与 CHW 会面的参与者中，对该计划的帮助有不同的反馈，而与 CHW 的接触并不能在 3 个月的随访中提高药物依从性。男性参与者、可能患有抑郁的参与者以及离诊所较远的参与者更有可能出现依从性挑战。研究结果表明，CHW 目前未得到充分利用来提供患者支持，并且在这种情况下可能对患者没有产生可观察到的益处，这代表了一个错过的机会，无法解决患者面临的挑战，包括抑郁和焦虑。
