@article{776a61ffe2a94e088317549da481a4ef,
title = "Provision of HIV services by community health workers should be strengthened to achieve full programme potential: a cross-sectional analysis in rural South Africa",
abstract = "Objective South Africa's community health workers (CHWs) provide a bridge between the primary healthcare (PHC) facility and its community. We conducted a cross-sectional analysis to determine the contribution of the community-based HIV programme (CBHP) to the overall HIV programme. Methods We collected service provision data from the daily activity register of CHWs attached to 12 PHC facilities in rural Mopani District, South Africa. Personal identifiers of individuals referred to the facility for HIV services were recorded and verified against facility routine patient registers to determine the effectiveness of referral. Results HIV services were provided on 18 927 occasions; 30% of the total activities performed by CHWs during the study period. CHWs assessed 12 159 individuals for HIV risk (13% coverage of the study population); only 290 (2%) were referred for HIV testing services. Referral was effective in 213 (73%) individuals; evidence of an HIV-positive status was found for 38 (18%) individuals. However, 30 (79%) of these individuals were referred by CHWs despite being on ART. Adherence support was provided during 5657 visits; only one individual was referred for complications. Finally, of the 864 individuals lost to the ART programme, CHWs managed to find 452 (52%) for referral back to the facility; only 241 (53%) of these were (re)initiated on ART. Conclusions Provision of HIV services by CHWs should be strengthened to fully deliver on the programme's potential. Human resource investment, home-based HIV testing and improved tracing models constitute potential strategies to enhance CHWs impact on the HIV programme.",
keywords = "community health workers, human immunodeficiency virus, primary healthcare, HUMAN-RESOURCES, HOME, OUTCOMES, LINKAGE, CARE",
author = "N. Naidoo and N. Matlakala and J. Railton and S. Khosa and G. Marincowitz and Igumbor, {J. O.} and McIntyre, {J. A.} and Struthers, {H. E.} and Peters, {R. P. H.}",
note = "Funding Information: This study is made possible by the American people through the US President's Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) under cooperative agreement number 674-A-12-00015 to the Anova Health Institute. The contents are the responsibility of Anova Health Institute and do not necessarily reflect the views of USAID or the United States Government. The funding body did not play a role in the design of the study, data collection, analysis, interpretation of data and in writing the manuscript. This research project was supported by a postgraduate training scholarship from the Fogarty and NIAID, The UNC-Wits AIDS Implementation Science and Cohort Analyses Training Grant (Grant number: 5D43TW009774-02). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty and NIAID. Funding Information: This study is made possible by the American people through the US President{\textquoteright}s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID) under cooperative agreement number 674-A-12-00015 to the Anova Health Institute. The contents are the responsibility of Anova Health Institute and do not necessarily reflect the views of USAID or the United States Government. The funding body did not play a role in the design of the study, data collection, analysis, interpretation of data and in writing the manuscript. This research project was supported by a postgraduate training scholarship from the Fogarty and NIAID, The UNC-Wits AIDS Implementation Science and Cohort Analyses Training Grant (Grant number: 5D43TW009774-02). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty and NIAID. Publisher Copyright: {\textcopyright} 2019 John Wiley & Sons Ltd",
year = "2019",
month = apr,
doi = "10.1111/tmi.13204",
language = "English",
volume = "24",
pages = "401--408",
journal = "Tropical Medicine & International Health",
issn = "1360-2276",
publisher = "Wiley",
number = "4",
}