scholarly journals Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand

Sexual Health ◽  
2018 ◽  
Vol 15 (6) ◽  
pp. 542 ◽  
Author(s):  
Nittaya Phanuphak ◽  
Thanthip Sungsing ◽  
Jureeporn Jantarapakde ◽  
Supabhorn Pengnonyang ◽  
Deondara Trachunthong ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Scale Up ◽  
Incidence Rates ◽  
Key Populations ◽  
National Guidelines ◽  
Condomless Sex ◽  
Key Population ◽  
Exposure Prophylaxis

Background No data are available on the feasibility of pre-exposure prophylaxis (PrEP) delivered by trained key population (KP) community health workers. Herein we report data from the KP-led Princess PrEP program serving men who have sex with men (MSM) and transgender women (TGW) in Thailand. Methods: From January 2016 to December 2017, trained MSM and TGW community health workers delivered same-day PrEP service in community health centres, allowing clients to receive one PrEP bottle to start on the day of HIV-negative testing. Visits were scheduled at Months 1 and 3, and every 3 months thereafter. Uptake, retention and adherence to PrEP services and changes in risk behaviours over time are reported. Results: Of 1467 MSM and 230 TGW who started PrEP, 44.1% had had condomless sex in the past 3 months. At Months 1, 3, 6, 9 and 12, retention was 74.2%, 64.0%, 56.2%, 46.7% and 43.9% respectively (lower in TGW than MSM at all visits; P<0.001), with adherence to at least four PrEP pills per week self-reported by 97.4%, 96.8%, 96.5%, 97.5% and 99.5% of respondents respectively (no difference between MSM and TGW). Logistic regression analysis identified age >25 years, being MSM and having at least a Bachelors degree significantly increased retention. Condomless sex did not change over the 12-month period (from 47.2% to 45.2%; P=0.20). New syphilis was diagnosed in 4.9% and 3.0% of PrEP clients at Months 6 and 12 (cf. 7.0% at baseline; P=0.007). Among PrEP adherers and non-adherers, there were one and six HIV cases of seroconversion respectively, which resulted in corresponding HIV incidence rates (95% confidence interval) of 0.27 (0.04–1.90) and 1.36 (0.61–3.02) per 100 person-years. Conclusion: Our KP-led PrEP program successfully delivered PrEP to MSM and TGW. Innovative retention supports are needed, especially for TGW and those who are young or with lower education levels. To scale-up and sustain KP-led PrEP programs, strong endorsement from international and national guidelines is necessary.

Improving use of maternal care services among married adolescent girls: an intervention study in rural India

2020 ◽  
pp. 1-20
Author(s):  
Ashok Dyalchand ◽  
Rohini Prabha Pande ◽  
Gopal Kulkarni ◽  
Manisha Khale
Keyword(s):  
Antenatal Care ◽  
Community Health ◽  
Community Health Workers ◽  
Adolescent Girls ◽  
Maternal Care ◽  
Health Workers ◽  
Care Delivery ◽  
Scale Up ◽  
Care Services ◽  
Study Sites

Abstract This study examined the effect of the Safe Adolescent Transition and Health Initiative (SATHI) programme on the use of maternal care services among rural, pregnant adolescents in India. This was an intensive community-based, multi-site intervention project conducted in Maharashtra state between 2008 and 2011. Its aims were to improve the reproductive health of married adolescent girls and avert the adverse consequences of early motherhood. It had a quasi-experimental, case-control, pre-post design to enable rigorous evaluation. This study used cross-sectional data from 644 married girls aged under 19 years at baseline and 802 at endline to assess the maternal care outcomes of antenatal care, delivery and postnatal services and nutrition during pregnancy. Difference-in-differences analysis showed that all outcomes improved significantly in the study sites between baseline and endline, and the improvement in study sites was significantly larger than in the control sites. Multivariate analysis showed a statistically significant dose–response effect of intervention participation for antenatal care, pregnancy nutrition and postnatal care. Study participation was not statistically significantly associated with higher rates of safe or institutional delivery. The analysis suggests that training and supporting community health workers to work with married adolescent girls using interpersonal communication and interacting frequently with them and their families and communities can significantly improve the use of maternal care services among this population. With almost a million community health workers and 200,000 auxiliary nurse midwives at the community level providing primary level care in India, this intervention offers a proven strategy to replicate and scale-up to reach large numbers of married adolescent girls who do not currently use maternal care services.

scholarly journals The use of low-cost ruggedized Android tablets to augment in-service training of community health workers in Mukono, Uganda: perspectives and lessons learned from the field

2021 ◽  
Vol 21 (3) ◽  
pp. 1482-1490
Author(s):  
Christina E Stiles ◽  
Edward O’Neil Jr ◽  
Kenneth Kabali ◽  
James O’Donovan
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Low Cost ◽  
Local Level ◽  
Scale Up ◽  
Lessons Learned ◽  
Sub Saharan Africa ◽  
Refresher Training ◽  
Service Training

Background: Despite potential for community health workers (CHWs) to effectively reduce morbidity and mortality in sub-Saharan Africa, they still face multiple barriers including access to on-going and refresher training. Digital technology offers a potential solution to improve the provision of ongoing training for CHWs. Objectives: This report shares participant insights and experiences following the implementation of a mobile health (mHealth) assisted Integrated Community Case Management (iCCM) refresher training programme for CHWs in Mukono, Uganda. We seek to document benefits and challenges of such an approach. Methods: CHWs were trained to recognize, treat and prevent childhood pneumonia via locally made videos preloaded onto low cost, ruggedized Android tablets. Subsequent interviews were compiled with key stakeholders including CHWs, CHW leaders and programme supervisors to better understand the strengths, barriers and lessons learned following the interven- tion. Results: Success factors included the establishment of CHW leadership structures, the ability to use the tablets to learn on an “any pace, any place” basis and using the tablets to conduct community teaching and outreach. Barriers included appro- priate consideration of the implementation timeline and avoiding a “one size fits all” approach to digital literacy training. Conclusions: The strength of the program stemmed from a grassroots approach that prioritized stakeholder input at all stages. Leadership at a local level, a history of local engagement and trust built up over a period time were also integral. As organizations aim to scale up digitally enhanced training initiatives, it is paramount that attention is paid to these human factors which are key for program success. Keywords: Low-cost ruggedized Android tablets; in-service training; community health workers; Mukono.

scholarly journals Training Community Health Workers to Scale-Up HIV Care in Rural Lesotho: Implementation Lessons from the Field

2012 ◽  
Vol 02 (03) ◽  
pp. 135-142 ◽  
Author(s):  
Jonas Rigodon ◽  
Keith Joseph ◽  
Salmaan Keshavjee ◽  
Corrado Cancedda ◽  
Mona Haidar ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Scale Up ◽  
Hiv Care ◽  
Training Community

scholarly journals Contribution of community health workers to primary health care performance in Brazil

2020 ◽  
Vol 54 ◽  
pp. 143
Author(s):  
Alaneir de Fátima dos Santos ◽  
Hugo André da Rocha ◽  
Ângela Maria de Lourdes Dayrell de Lima ◽  
Daisy Maria Xavier de Abreu ◽  
Érica Araújo Silva ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Scale Up ◽  
Health Care Facilities ◽  
Children's Health ◽  
Children’S Health ◽  
Primary Health

OBJECTIVE: To associate the strength of community health workers interventions with primary health care strategies for women’s and children’s health, diabetes, and hypertension. METHODS: This is a cross-sectional study assessing 29,778 family health teams working in primary health care in Brazil in 2014. The association between community health workers activity levels and primary health care facilities was analyzed using multiple logistic regression. RESULTS: We found higher levels of community health workers activities strongly associated with primary health care practices (OR = 6.88) for those activities targeting hypertension management, followed by children’s health (OR = 6.56), and women’s health (OR = 6.21). CONCLUSIONS: At a time when Brazil discusses whether community health workers should or should not remain in the same scale-up and skill level as they currently are, our results reinforce the importance of these workers for the care model advocated by the Brazilian Unified Health System.

scholarly journals Using technology to scale-up training and supervision of community health workers in the psychosocial management of perinatal depression: a non-inferiority, randomized controlled trial

2019 ◽  
Vol 6 ◽  
Author(s):  
Atif Rahman ◽  
Parveen Akhtar ◽  
Syed Usman Hamdani ◽  
Najia Atif ◽  
Huma Nazir ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Controlled Trial ◽  
Scale Up ◽  
World Health ◽  
Face To Face ◽  
Randomized Controlled ◽  
Training And Supervision

Background.The Thinking Healthy Programme (THP) is an evidence-based psychological intervention endorsed by the World Health Organization, tailored for non-specialist health workers in low- and middle-income countries. However, training and supervision of large numbers of health workers is a major challenge for the scale-up of THP. We developed a ‘Technology-Assisted Cascaded Training and Supervision system’ (TACTS) for THP consisting of a training application and cascaded supervision delivered from a distance.Methods.A single-blind, non-inferiority, randomized controlled trial was conducted in District Swat, a post-conflict area of North Pakistan. Eighty community health workers (called Lady Health Workers or LHWs) were randomly assigned to either TACTS or conventional face-to-face training and supervision by a specialist. Competence of LHWs in delivering THP post-training was assessed by independent observers rating a therapeutic session using a standardized measure, the ‘Enhancing Assessment of Common Therapeutic factors’ (ENACT), immediately post-training and after 3 months. ENACT uses a Likert scale to score an observed interaction on 18 dimensions, with a total score of 54, and a higher score indicating greater competence.Results.Results indicated no significant differences between health workers trained using TACTS and supervised from distancev.those trained and supervised by a specialist face-to-face (mean ENACT score M  =  24.97,s.d.  =  5.95v.M =  27.27,s.d.  =  5.60,p  =  0.079, 95% CI 4.87–0.27) and at 3 months follow-up assessment (M  =  44.48,s.d.  =  3.97v.M =  43.63,s.d.  =  6.34,p  =  0.53, CI −1.88 to 3.59).Conclusions.TACTS can provide a promising tool for training and supervision of front-line workers in areas where there is a shortage of specialist trainers and supervisors.

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