NASTAD Ethiopia Launches Assessment of Community Health Support Workers Intervention for PLHIV

By Tibebe Shenie September 28, 2015

Map of SNNPR
Map of SNNPR

In many countries around the world, a critical gap exists in the HIV Care Continuum, where many patients entering HIV care are lost to follow-up, often within the first 1-2 years. This problem persists in Ethiopia, where an estimated 730,000 people are living with HIV. Among newly diagnosed HIV patients enrolled in care, treatment default continues to be a major problem in Ethiopia and elsewhere in sub-Saharan Africa. Many of these patients who are lost to follow-up are likely to die without treatment; those who return to care often present with advanced disease.

NASTAD’s studies in Ethiopia have indicated that HIV patients in rural settings (where HIV is increasingly treated) face multiple challenges that may impact retention in care and health status, including lack of knowledge about HIV treatment, internal and external stigma, lack of social support, and poor communication with HIV clinic staff.

To help address these and other challenges in retention in care, including shortages of trained clinical providers, HIV care programs in Ethiopia incorporate community health support workers (CHSWs) to provide specific services, including patient outreach. However, the evidence for efficacy of CHSW programs is largely based on observational and single site studies, and factors associated with positive outcomes are not well understood.

In August 2015, NASTAD Ethiopia, in collaboration with the University of Minnesota, launched a new research project to evaluate one such community support workers intervention in the South Nations, Nationalities and Peoples Region (SNNPR) of Ethiopia, where NASTAD and the University have been conducting collaborative research for the past five years. The research project, intended to reduce treatment default, and to improve the physical and emotional health of people living with HIV (PLHIV), is financed by The National Institutes of Health (NIH) for five years.

NASTAD Ethiopia Assesssment Launch
CHSW Training Workshop

Regional health officials, zonal health department heads and health facility directors attended the research project launch, held in Hawassa, the capital city of SNNPR. Opening remarks were delivered by Ato Mena Mekuria, Deputy Director of the Regional Health Bureau, and the project was presented and discussed. The research project has been named "SHAMA", which in Amharic means "candle" and is used to signify the work of "spreading light" for people living with HIV. Sixteen hospitals and 16 health centers have been selected for this assessment, and randomly allocated to the CHSW intervention or standard of care arms. Over 2,600 participants are expected to be enrolled and followed for three consequent years.

NASTAD Ethiopia, in collaboration with the University of Minnesota, has employed and trained one regional coordinator and eleven facility-based project officers to work on the project. In addition, NASTAD Ethiopia has recruited and trained 64 volunteer CHSWs to be assigned to the intervention health facilities. Enrollment of participants will begin in October 2015.

This project has strong research implications to develop evidence-based interventions for future community-based programs using support workers. Such a model can strengthen the HIV care continuum and support decentralized HIV care through improved retention in HIV care in resource-limiting settings.

NASTAD Ethiopia Assessment Workshop
CHSW Launch Workshop

Salle Workneh, Community HIV Care & Support Senior Specialist, Abera Haile Michael, SHAMA Technical Officer, NASTAD Ethiopia, Anne Sites, Senior Manager, and Dr. Alan Lifson, Division of Epidemiology and Community Health at University of Minnesota, also contributed to the development of this post.

If you are interested in learning more about the community health workers support intervention in NASTAD Ethiopia, please contact Anne Sites

Visit NASTAD.org/global to learn more about NASTAD Global.