Share This Article:

Training Community Health Workers to Scale-Up HIV Care in Rural Lesotho: Implementation Lessons from the Field

Abstract Full-Text HTML Download Download as PDF (Size:207KB) PP. 135-142
DOI: 10.4236/wja.2012.23019    4,200 Downloads   6,793 Views   Citations

ABSTRACT

Community health workers (CHWs) have long played an important role in the management of complex health problems, especially in resource-poor settings. Although there is a large literature regarding the use of CHWs around the world, there is little detail about how these workers are selected, trained and utilized in the field. Lesotho has one of the highest rates of HIV in the world, with an estimated 25% of the general population infected with the disease; at the same time, there is a significant health human resources shortage in Lesotho with an estimated 60% of health posts left vacant. Community health workers have the potential to play a major role in HIV treatment scale-up in the country, and in 2006, a CWH-based project called "The Rural Initiative" was started in the remote mountain regions of the country. More than 1000 CHWs were trained and employed through this program between June 2006 and December 2008. This paper will review the CHW program in detail, with a focus on recruitment, training, ongoing supervision and support, and the larger public health implications of the CHW program in Lesotho. It is hoped this program can serve as a practical model for other programs working with or in need of CHWs.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

J. Rigodon, K. Joseph, S. Keshavjee, C. Cancedda, M. Haidar, N. Lesia, L. Ramangoaela and J. Furin, "Training Community Health Workers to Scale-Up HIV Care in Rural Lesotho: Implementation Lessons from the Field," World Journal of AIDS, Vol. 2 No. 3, 2012, pp. 135-142. doi: 10.4236/wja.2012.23019.

References

[1] H. Standing and A. M. Chowdhury, “Producing Effective Knowledge Agents in a Pluralistic Environment: What Future for Community Health Workers?” Social Science & Medicine, Vol. 66, No. 10, 2008, pp. 2096-2107. doi:10.1016/j.socscimed.2008.01.046
[2] B. Devkota and E. van Teijlingen, “Demystifying the Maoist Barefoot Doctors of Nepal,” Medicine, Conflict & Survival, Vol. 26, No. 2, 2010, pp. 108-123. doi:10.1080/13623699.2010.491382
[3] L. M. Perez and J. Martinez, “Community Health Workers: Social Justice and Policy Advocates for Community Health and Well-Being,” American Journal of Public Health, Vol. 98, No. 1, 2008, pp. 11-14. doi:10.2105/AJPH.2006.100842
[4] A. Haines, D. Sanders, U. Lehmann, A. K. Rowe, J. E. Lawn, S. Jan, D. G. Walker and Z. Bhutta, “Achieving Child Survival Goals: Potential Contribution of Community Health Workers,” Lancet, Vol. 369, No. 9579, 2007, pp. 2121-2131. doi:10.1016/S0140-6736(07)60325-0
[5] S. A. Lewin, J. Dick, P. Pond, M. Zwarenstein, G. Aja, B. van Wyk, X. Bosch-Capblanch and M. Patrick, “Lay Health Workers in Primary and Community Health Care,” Cochrane Database of Systematic Reviews, Vol. 1, 2005, Article ID: CD004015. doi:10.1002/14651858.CD004015.pub2
[6] M. A. Nemcek and R. Sabatier, “State of Evaluation: Community Health Workers,” Public Health Nursing, Vol. 20, No. 4, 2003, pp. 260-270. doi:10.1046/j.1525-1446.2003.20403.x
[7] J. M. Stacciarini, A. Rosa, M. Ortiz, D. B. Munari, G. Uicab and M. Balam, “Promotoras in Mental Health: A Review of English, Spanish, and Portuguese Literature,” Family & Community Health, Vol. 35, No. 2, 2012, pp. 92-102.
[8] C. Giugliani, E. Harzheim, M. S. Duncan and B. B. Duncan, “Effectiveness of Community Health Workers in Brazil: A Systematic Review,” Journal of Ambulatory Care Management, Vol. 34, No. 4, 2011, pp. 326-338.
[9] L. Ruggiero, A. Castillo, L. Quinn and M. Hochwert, “Translation of the Diabetes Prevention Program’s Lifestyle Intervention: Role of Community Health Workers,” Current Diabetes Reports, Vol. 12, No. 2, 2012, pp. 127-137. doi:10.1007/s11892-012-0254-y
[10] C. F. Reynolds III, P. Cuijpers, V. Patel, A. Cohen, A. Dias, N. Chowdhary, O. I. Okereke, M. A. Dew, S. J. Anderson, S. Mazumdar, F. Lotrich and S. M. Albert, “Early Intervention to Reduce the Global Health and Economic Burden of Major Depression in Older Adults,” Annual Review of Public Health, Vol. 33, 2012, pp. 123-135. doi:10.1146/annurev-publhealth-031811-124544
[11] M. E. Herce, J. A. Chapman, A. Castro, G. Garcia-Salyano and K. Khoshnood, “A Role for Community Health Promoters in Tuberculosis Control in the State of Chiapas, Mexico,” Journal of Community Health, Vol. 35, No. 2, 2010, pp. 182-189. doi:10.1007/s10900-009-9206-0
[12] D. G. Datiko and B. Lindtjorn, “Cost and Cost-Effectiveness of Smear-Positive Tuberculosis Treatment by Health Extension Workers in Southern Ethiopia: A Community Randomized Trial,” PLoS One, Vol. 5, No. 2, 2010, Article ID: e9158. doi:10.1371/journal.pone.0009158
[13] S. Alamo, F. Wabwire-Mangen, E. Kenneth, P. Sunday, M. Laga and R. L. Colebunders, “Task-Shifting to Community Health Workers: Evaluation of the Performance of a Peer-Led Model in an Antiretroviral Program in Uganda,” AIDS Patient Care and STDs, Vol. 26, No. 2, 2012, pp. 101-107. doi:10.1089/apc.2011.0279
[14] S. Kenya, N. Chida, S. Symes and G. Shor-Posner, “Can Community Health Workers Improve Adherence to Highly Active Antiretroviral Therapy in the USA? A Review of the Literature,” HIV Medicine, Vol. 12, No. 9, 2011, pp. 525-534. doi:10.1111/j.1468-1293.2011.00921.x
[15] L. C. Ivers, J. G. Jerome, K. A. Cullen, W. Lambert, F. Celletti and B. Samb, “Task-Shifting in HIV Care: A Case Study of Nurse-Centered Community-Based Care in Rural Haiti,” PLoS One, Vol. 6, No. 5, 2011, Article ID: e19276. doi:10.1371/journal.pone.0019276
[16] N. van Ginneken, S. Lewin and V. Berridge, “The Emergence of Community Health Worker Programmes in the Late Apartheid Era in South Africa: An Historical Analysis,” Social Science & Medicine, Vol. 71, No. 6, 2010, pp. 1110-1118. doi:10.1016/j.socscimed.2010.06.009
[17] E. Wouters, W. Van Damme, D. van Rensburg, H. Meulemans, “Impact of Baseline Health and Community Support on Antiretroviral Treatment Outcomes in HIV Patients in South Africa,” AIDS, Vol. 22, No. 18, 2008, pp. 2545-2548. doi:10.1097/QAD.0b013e32831c5562
[18] N. Ford, K. Kranzer, K. Hilderbrand, G. Jouquet, E. Goemaere, N. Vlahakis, L. Trivino, L. Makakole and H. Bygrave, “Early Initiation of Antiretroviral Therapy and Associated Reduction in Mortality, Morbidity and Defaulting in a Nurse-Managed, Community Cohort in Lesotho,” AIDS, Vol. 24, No. 17, 2010, pp. 2645-2650. doi:10.1097/QAD.0b013e32833ec5b2
[19] E. Gouws, K. A. Stanecki, R. Lyerla and P. D. Ghys, “The Epidemiology of HIV Infection among Young People Aged 15 - 24 Years in Southern Africa,” AIDS, Vol. 22, No. S4, 2008, pp. S5-S16. doi:10.1097/01.aids.0000341773.86500.9d
[20] J. J. Furin, H. L. Behforouz, S. S. Shin, J. S. Mukherjee, J. Bayona, P. E. Farmer, J. Y. Kim and S. Keshavjee, “Expanding Global HIV Treatment: Case Studies from the Field,” Annals of the New York Academy of Sciences, Vol. 1136, 2008, pp. 12-20. doi:10.1196/annals.1425.004
[21] J. K. Joseph, J. Rigodon, C. Cancedda, M. Haidar, N. Lesia, L. Ramanagoela and J. Furin, “Lay Health Workers and HIV Care in Rural Lesotho: A Report from the Field. AIDS Patient Care & STDs, Vol. 26, No. 3, 2012, pp. 141-147. doi:10.1089/apc.2011.0209
[22] J. J. Furin, J. Rigodon, C. Cancedda, S. Keshavjee, K. J. Seung, M. Letsie, J. Y. Kim, J. K. Joseph, “Improved Case Detection of Active Tuberculosis Associated with an Antiretroviral Treatment Program in Lesotho,” International Journal of Tuberculosis & Lung Disease, Vol. 11, No. 10, 2007, pp. 1154-1156.
[23] J. Furin, M. Shutts and S. Keshavjee, “Aviation and the Delivery of Medical Care in Remote Regions: The Lesotho HIV Experience,” Aviation Space & Environmental Medicine, Vol. 79, No. 2, 2008, pp. 136-138. doi:10.3357/ASEM.2134.2008
[24] J. Furin, “The Role of Traditional Healers in Community-Based HIV Care in Rural Lesotho,” Journal of Community Health, Vol. 36, No. 5, 2011, pp. 849-856. doi:10.1007/s10900-011-9385-3
[25] M. L. Rich, A. C. Miller, P. Niyigena, M. F. Franke, J. B. Niyonzima, A. Socci, P. C. Drobac, M. Hakizamungu, A. Mayfield, R. Ruhayisha, H. Epino, S. Stulac, C. Cancedda, A. Karamaga, S. Niyonzima, C. Yarbrough, J. Fleming, C. Amoroso, J. Mukherjee, M. Murray, P. Farmer and A. Binagwaho, “Excellent Clinical Outcomes and High Retention in Care among Adults in a Community-Based HIV Treatment Program in Rural Rwanda,” Journal of Acquired Immune Deficiency Syndromes, Vol. 59, No. 3, 2012, pp. e35-e42.
[26] L. C. Ivers, J. S. Mukherjee, F. R. Leandre, J. Rigodon, K. A. Cullen and J. Furin, “South-South Collaboration in Scale-Up of HIV Care: Building Human Capacity for Care,” AIDS, Vol. 24, Suppl. 1, 2010, pp. S73-S78. doi:10.1097/01.aids.0000366085.14064.6f
[27] R. G. Jones, A. N. Trivedi and J. Z. Ayanian, “Factors Influencing the Effectiveness of Interventions to Reduce Racial and Ethnic Disparities in Health Care,” Social Science & Medicine, Vol. 70, No. 3, 2011, pp. 337-341. doi:10.1016/j.socscimed.2009.10.030
[28] A. D. Harries, I. D. Rusen, T. Reid, A. K. Detjen, S. D. Berger, K. Bissell, S. G. Hinderaker, M. Edginton, M. Fussell, P. I. Fujiwara and R. Zachariah, “The Union and Medecins Sans Frontieres Approach to Operational Research,” International Journal of Tuberculosis & Lung Disease, Vol. 15, No. 2, 2011, pp. 144-154.
[29] M. M. Alsan, M. Westerhaus, M. Herce, K. Nakashima and P. E. Farmer, “Poverty, Global Health, and Infectious Disease: Lessons from Haiti and Rwanda,” Infectious Disease Clinics of North America, Vol. 25, No. 3, 2011, pp. 611-622. doi:10.1016/j.idc.2011.05.004
[30] Partners in Health, “Accompagnateurs Curriculum,” Boston, 2012.
http://www.pih.org/publications/entry/accompagnateurs-curriculum

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.