Mixed Methods, Implementation Science Evaluation of a Community Health Worker Strategy for HIV Service Engagement in...

Area of Science:

• Implementation science
• Public health
• HIV/AIDS research

Background:

• A community health worker (CHW) strategy,
• Health Scouts
• , was implemented to improve HIV care uptake and ART coverage.
• An implementation science evaluation was conducted to assess outcomes and identify areas for improvement.

Purpose of the Study:

• To evaluate the effectiveness, reach, adoption, implementation fidelity, and maintenance of the Health Scouts CHW strategy using the RE-AIM framework.
• To identify facilitators and barriers to the strategy's success.
• To provide recommendations for future iterations and scale-up.

Main Methods:

• Quantitative analysis of a community survey (n=1903), CHW logs, and phone application data.
• Qualitative in-depth interviews (n=72) with CHWs, clients, staff, and community leaders.
• Utilized the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.

Main Results:

• Thirteen Health Scouts conducted 11,221 counseling sessions reaching 2532 unique clients.
• Awareness of Health Scouts was high (95.7%), but overall reach was suboptimal (30.7%).
• Barriers to reach included client lifestyles and stigma; effectiveness was high, adoption facilitated by positive impacts, and implementation fidelity varied.

Conclusions:

• The CHW strategy demonstrated moderate success in an HIV hyperendemic setting.
• The strategy is fundamentally sound but requires adaptations to improve reach, particularly for underserved populations.
• Consideration for adoption and scale-up in comprehensive HIV control efforts is recommended.