The Lived Experiences of Ugandan Community Health Workers Engaged in Prevention of Vertical Transmission of HIV and a Capacity-Building Intervention.

Abstract

Objective: To explore the lived experiences of community health workers (CHW) engaged in efforts toward the elimination of vertical transmission (EVT) of HIV and to assess the impact of a capacity-building training intervention.

Design: The study consisted of (1) a qualitative assessment of lived experiences of CHWs; (2) a capacity-building training intervention responsive to identified needs; and (3) assessment of the training intervention using pre- and postintervention questionnaires.

Methods: Focus group discussions and semistructured key informant interviews in addition to CHW training sessions for HIV/EVT were held in 1 rural and 1 semiurban setting in Uganda, based on training materials developed by the World Health Organization and the United States Agency for International Development (USAID). We used standardized pre- and postintervention questionnaires to assess comprehensive knowledge and accepting attitudes toward HIV.

Results: Qualitative exploration of the lived experience of 152 CHWs in 10 focus group discussions and 4 key informant interviews revealed several themes: (1) CHWs as bridges between health system and community; (2) CHW assets (tacit knowledge and shared social networks); (3) CHW challenges (stigma, secrecy, and ethical quandaries); (4) favorable community reception; and (5) need for continuing education and reinforcement of skills. In response to identified needs, a capacity-building intervention was designed and implemented with 143 CHWs participating in 10 sessions. The proportion of participants with comprehensive knowledge of HIV increased from 45% to 61% ( P = 0.006), and the proportion endorsing accepting attitudes increased from 63% to 76% ( P = 0.013).

Conclusion: CHWs are potentially valuable players in global EVT efforts. Ongoing training is needed to support community-level initiatives.