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Harmonizing community-based health worker programs for HIV: a narrative review and analytic framework.

Jan-Walter De Neve1,2, Chantelle Boudreaux3, Roopan Gill4

  • 1Institute of Public Health, Heidelberg University, Heidelberg, 69120, Germany. jwdeneve@mail.harvard.edu.

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Summary

Harmonizing community health worker (CHW) programs for HIV is crucial for improving performance and addressing fragmentation. This study defines harmonization and offers a framework to guide more effective, sustainable CHW initiatives.

Keywords:
Community health workersHIVHarmonizationLow- and middle-income countries

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Area of Science:

  • Public Health
  • Health Systems Strengthening
  • Community Health

Background:

  • Numerous community-based health worker (CHW) programs for HIV exist globally.
  • Diverse national and non-governmental initiatives raise concerns about compatibility in addressing health issues and resource utilization.
  • A need exists for coherent approaches and evidence on efficient, sustainable CHW program strategies.

Purpose of the Study:

  • To review and analyze the harmonization of CHW programs for HIV.
  • To define harmonization and identify priority areas for its implementation.
  • To develop a conceptual framework for analyzing CHW program harmonization.

Main Methods:

  • Conducted a narrative review of published and gray literature on CHW program harmonization.
  • Identified evidence on definitions, models, frameworks, and effects of program fragmentation.
  • Developed a conceptual framework for analyzing harmonization across key domains.

Main Results:

  • Identified a large number and diversity of CHW programs for HIV.
  • Defined three priority areas for harmonization: stakeholder coordination, health system integration, and program sustainability.
  • Proposed an analytic framework for assessing harmonization facilitators and barriers.

Conclusions:

  • Addressing fragmentation in CHW programs is essential for advancing and sustaining their roles in HIV services.
  • The study provides a framework to understand and achieve CHW program harmonization.
  • The findings aim to test the assumption that harmonization improves CHW performance.