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Uganda, Community Health Worker, HIV-AIDS

Alibhai, Arif A

Supervisor and department: Kipp, Walter Public Health Sciences

Examining committee member and department: Saunders, L Duncan Public Health Sciences Mill, Judith Nursing Menon, Devidas Public Health Sciences MacDonald, Wendy Grant MacEwan University

Department: School of Public Health Sciences


Date accepted: 2013-08-14T10:35:32Z

Graduation date: 2013-11

Degree: Doctor of Philosophy

Degree level: Doctoral

Abstract: Background: A research team from the University of Alberta and Uganda established a community based antiretroviral treatment ART program for AIDS patients in rural western Uganda. This program engaged laypersons as volunteer community health workers CHWs to support ART activities. Research Questions: This study examined whether CHWs could effectively perform a range of activities to support ART, how the elements of a volunteer CHW program functioned, and what patients, health workers and CHWs felt were the benefits to patients of using volunteer CHWs. Methods: This was a mixed methods study. Between 2006 and 2008, cross-sectional and longitudinal data were obtained from CHW surveys and focus groups, health worker focus groups, patient interviews, clinic charts, and program documents.Results: CHWs were able to effectively deliver drugs, monitor adherence to ART, and promote behaviour change and condoms for the prevention of HIV transmission. However, findings pointed to concerns regarding the ability of CHWs to identify side-effects of ART. After two years, 65.7% of patients achieved virologic suppression and 16.9% died. In multivariate analyses, having to travel one or more hours to the patient, compared to less than one hour, was the only statistically significant CHW characteristic that predicted virologic failure adjusted OR = 0.29, p = 0.002 and mortality adjusted HR = 4.52, p = 0.026. Patients and health workers attributed positive ART outcomes to the role of the CHWs in reducing the transport burden and wait times for patients. Patients valued the emotional and compassionate support to patients. The biggest challenges for CHWs were distances they had to travel, patient stigma, patient social issues, and community misperceptions about the CHW role. Some issues resolved with time and experience. Despite these challenges, the attrition rate for CHWs was only 2.4% over the two year period. CHWs felt highly motivated by the recognition and appreciation of the community and the opportunity to help reduce mortality within their community. Conclusions: The CHW program contributed to positive treatment outcomes for rural AIDS patients and provides recommendations for replication of this program to other areas of sub-Saharan Africa.

Language: English

DOI: doi:10.7939-R39S1KT6N

Rights: Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.

Autor: Alibhai, Arif A



University of Alberta        The effectiveness of a volunteer community health worker program to support  an antiretroviral treatment program for AIDS patients in western Uganda      by    Arif A. Alibhai            A thesis submitted to the Faculty of Graduate Studies and Research   in partial fulfillment of the requirements for the degree of         Doctor of Philosophy        Department of Public Health Sciences          ©Arif A. Alibhai  Fall 2013  Edmonton, Alberta          Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis  and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is  converted to, or otherwise made available in digital form, the University of Alberta will advise potential  users of the thesis of these terms.    The author reserves all other publication and other rights in association with the copyright in the thesis and,  except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or  otherwise reproduced in any material form whatsoever without the authors prior written permission.          DEDICATION      To the community volunteers in Rwimi subcounty who have worked selflessly  and tirelessly to serve their communities. They exemplify of the best qualities of  humanity and are my inspiration.                  ABSTRACT    Background: A research team from the University of Alberta and Uganda  established a community based antiretroviral treatment (ART) program for AIDS  patients in rural western Uganda. This program engaged laypersons as volunteer  community health workers (CHWs) to support ART ...

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