Novel community health worker strategy for HIV service engagement in a hyperendemic community in Rakai, Uganda: A pragmatic, cluster-randomized trial release_5a4roifvgbd7hp37ctctr6haba

by Larry W. Chang, Ismail Mbabali, Heidi Hutton, K. Rivet Amico, Xiangrong Kong, Jeremiah Mulamba, Aggrey Anok, Joseph Ssekasanvu, Amanda Long, Alvin G. Thomas, Kristin Thomas, Eva Bugos (+11 others)

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abstracts [{'sha1': 'b8a020f00ea54490fdceaac53967383c1af2422f', 'content': '<jats:sec id="sec001">\n<jats:title>Background</jats:title>\nEffective implementation strategies are needed to increase engagement in HIV services in hyperendemic settings. We conducted a pragmatic cluster-randomized trial in a high-risk, highly mobile fishing community (HIV prevalence: approximately 38%) in Rakai, Uganda, to assess the impact of a community health worker-delivered, theory-based (situated Information, Motivation, and Behavior Skills), motivational interviewing-informed, and mobile phone application-supported counseling strategy called "Health Scouts" to promote engagement in HIV treatment and prevention services.\n</jats:sec>\n<jats:sec id="sec002">\n<jats:title>Methods and findings</jats:title>\nThe study community was divided into 40 contiguous, randomly allocated clusters (20 intervention clusters, <jats:italic>n</jats:italic> = 1,054 participants at baseline; 20 control clusters, <jats:italic>n</jats:italic> = 1,094 participants at baseline). From September 2015 to December 2018, the Health Scouts were deployed in intervention clusters. Community-wide, cross-sectional surveys of consenting 15 to 49-year-old residents were conducted at approximately 15 months (mid-study) and at approximately 39 months (end-study) assessing the primary programmatic outcomes of self-reported linkage to HIV care, antiretroviral therapy (ART) use, and male circumcision, and the primary biologic outcome of HIV viral suppression (&lt;400 copies/mL). Secondary outcomes included HIV testing coverage, HIV incidence, and consistent condom use. The primary intent-to-treat analysis used log-linear binomial regression with generalized estimating equation to estimate prevalence risk ratios (PRR) in the intervention versus control arm. A total of 2,533 (45% female, mean age: 31 years) and 1,903 (46% female; mean age 32 years) residents completed the mid-study and end-study surveys, respectively. At mid-study, there were no differences in outcomes between arms. At end-study, self-reported receipt of the Health Scouts intervention was 38% in the intervention arm and 23% in the control arm, suggesting moderate intervention uptake in the intervention arm and substantial contamination in the control arm. At end-study, intention-to-treat analysis found higher HIV care coverage (PRR: 1.06, 95% CI: 1.01 to 1.10, <jats:italic>p</jats:italic> = 0.011) and ART coverage (PRR: 1.05, 95% CI: 1.01 to 1.10, <jats:italic>p</jats:italic> = 0.028) among HIV–positive participants in the intervention compared with the control arm. Male circumcision coverage among all men (PRR: 1.05, 95% CI: 0.96 to 1.14, <jats:italic>p</jats:italic> = 0.31) and HIV viral suppression among HIV–positive participants (PRR: 1.04, 95% CI: 0.98 to 1.12, <jats:italic>p</jats:italic> = 0.20) were higher in the intervention arm, but differences were not statistically significant. No differences were seen in secondary outcomes. Study limitations include reliance on self-report for programmatic outcomes and substantial contamination which may have diluted estimates of effect.\n</jats:sec>\n<jats:sec id="sec003">\n<jats:title>Conclusions</jats:title>\nA novel community health worker intervention improved HIV care and ART coverage in an HIV hyperendemic setting but did not clearly improve male circumcision coverage or HIV viral suppression. This community-based, implementation strategy may be a useful component in some settings for HIV epidemic control.\n</jats:sec>\n<jats:sec id="sec004">\n<jats:title>Trial registration</jats:title>\ <jats:ext-link xmlns:xlink="" ext-link-type="uri" xlink:href="" xlink:type="simple">NCT02556957</jats:ext-link>.\n</jats:sec>', 'mimetype': 'application/xml+jats', 'lang': None}]
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title Novel community health worker strategy for HIV service engagement in a hyperendemic community in Rakai, Uganda: A pragmatic, cluster-randomized trial
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