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 post-intervention questionnaires.

Methods: Focus group discussions (FGD) and semi-structured key informant interviews (KII) in addition to CHW training sessions for HIV/EVT were held in one rural and one semi-urban setting in Uganda, based on training materials developed by the WHO and USAID. We used standardized pre- and post-intervention questionnaires to assess comprehensive knowledge and accepting attitudes toward HIV.

Results: Qualitative exploration of the lived experience of 152 CHWs in ten FGDs and four KIIs 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.