Home visiting programs for HIV-affected families: a comparison of service quality between volunteer-driven and paraprofessional models

Kidman, Rachel; Nice, Johanna; Taylor, Tory M.; Thurman, Tonya R.

doi:10.1080/17450128.2014.954025

Cited by 12 publications

(9 citation statements)

References 17 publications

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“…However, the intervention will need to be tailored to context. For example, this intervention was delivered in an urban setting and may require adaptation for implementation in rural settings where CHWs may have to travel longer distances in difficult terrain [ 36 ]. This is likely to have implications on the number of visits each CHW can conduct each day, the total number of successful visits each CHW can make, and the time spent travelling to each participant household by CHWs.…”

Section: Discussionmentioning

confidence: 99%

Community health worker support to improve HIV treatment outcomes for older children and adolescents in Zimbabwe: a process evaluation of the ZENITH trial

et al. 2018

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BackgroundCommunity health worker (CHW)-delivered support visits to children living with HIV and their caregivers significantly reduced odds of virological failure among the children in the ZENITH trial conducted in Zimbabwe. We conducted a process evaluation to assess fidelity, acceptability, and feasibility of this intervention to identify lessons that could inform replication and scale-up of this approach.MethodsField manuals kept by each CHW, records from monthly supervisory meetings, and participant data collected throughout the trial were used to assess the intervention’s implementation. Data extracted from field manuals included visit type, content, and duration. Minutes from monthly supervisory meetings were used to capture CHW attendance.ResultsThe trial enrolled 172 participants in the intervention arm of whom 5 subsequently refused all visits, 1 died before the intervention could be delivered, and 1 could not be located. Manuals for 8 participants were not returned, 3 were incorrectly entered, and 1 manual was lost. We had 154 manuals available for analysis.A total of 1553 visits were successfully conducted (median 11 per participant, range 1–20). Additionally, CHWs made 85 visits where they were unable to make contact with the family. Thirteen (8.4%) participants received 5 or fewer visits, 10 moved out of the study area, and 3 died. CHWs discussed disclosure with the child/family for over 89% of participants and assisted clients with developing and reviewing their personal treatment plan with over 85% of participants. Of the 20 CHWs (3 male, 17 female) selected to implement the intervention, 19 were retained at the end of the trial.ConclusionsThe intervention was acceptable to participants with most receiving and accepting the required number of visits. Key strenghts were high staff retention and fidelity to the intervention. This community-based intervention was an acceptable and feasible approach to reduce virological failure among children living with HIV.Trial registrationThe ZENITH trial was registered on 25 October 2012 in the Pan African Clinical Trials Registry under the trial registration number PACTR201212000442288. It can be found at http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201212000442288.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0762-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Community health worker support to improve HIV treatment outcomes for older children and adolescents in Zimbabwe: a process evaluation of the ZENITH trial

et al. 2018

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“…The country’s community-based child and youth care workers (CYCWs) use the Isibindi model of care to serve vulnerable children around the country [ 1 ], with a principal focus on providing support to the more than 2 million children orphaned or otherwise affected by HIV and AIDS [ 2 ]. Services provided range from HIV prevention and healthcare referrals to psychological support, education assistance, child protection, linkages to social grants, and more [ 3 ]. Isibindi was formally developed in 2005 after related activities dating back to 2000, by the country’s National Association of Child Care Workers (NACCW).…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have found that Isibindi programming is associated with positive outcomes for children and adolescents including increased access to social grants and basic material resources [ 3 , 5 ] as well as lower HIV risk behaviour [ 6 ]. Evidence from qualitative research, however, suggests that these results may come at a high personal cost to Isibindi CYCWs in South Africa, who report experiencing work-related stress, secondary trauma, difficult working conditions, and poor stakeholder relations [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with retention intentions among Isibindi child and youth care workers in South Africa: results from a national survey

et al. 2018

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BackgroundChild and youth care workers (CYCWs) are a crucial and growing component of South Africa’s national response to HIV and AIDS and other issues affecting children and families. CYCWs use the community-centred Isibindi model of care to reach the most vulnerable with key services including psychosocial, health, economic and education support. Like others in similar professions, they may be at risk for occupational challenges affecting retention.MethodsThis study uses data from the first nationally representative survey of CYCWs in South Africa to identify factors associated with workers’ retention intentions. Data were collected in 2015 as part of a formative evaluation conducted around the mid-point of a nationwide Isibindi programme expansion. A total of 1158 CYCWs from 78 sites participated. The response rate for the sample was 87%. Questions addressed demographics, work history, retention intentions, training, mentorship and supervision experiences, workload and remuneration. Mixed effects regression models with random intercepts for project site and mentor were used to estimate factors associated with retention intentions.ResultsHigh-quality mentorship and frequent supervision support retention intentions among CYCWs. Respondents who indicated that wanting to help children or the community was their primary motivator for seeking work as a CYCW were also more likely to report intending to continue working as a CYCW. High perceived workloads and feeling threatened or unsafe on the job were negatively associated with retention intentions. As CYCWs gained experience, they were also less likely to intend to stay.ConclusionsUnderstanding the factors affecting retention in the CYCW workforce is vital to helping vulnerable children and families across South Africa access key social and health services. Findings highlight the importance of mentoring and supervision as part of the Isibindi model and the value of support for manageable workloads, workplace safety, and career advancement opportunities for promoting worker retention.

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“…While the disparity in financial remuneration between the CHWs and the Change Agents emerged as a key tension in this case, both the research presented here, and the literature highlight that financial remuneration is not the sole motivation that individuals have for becoming community‐based healthcare workers (Akintola, ; Greenspan et al, ; Kidman, Nice, Taylor, & Thurman, ; Mwai et al, ; Pallas et al, ). A desire to learn, as well as to improve the lives of loved ones and the general health and well‐being of the community, are also key factors that motivate individuals to participate in such programmes.…”

Section: Discussionmentioning

confidence: 82%

Responding to the health needs of migrant farm workers in South Africa: Opportunities and challenges for sustainable community‐based responses

Gruchy

2019

Health Soc Care Community

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Reflecting global trends, migrant farm workers in South Africa experience challenges in accessing healthcare. On the commercial farms in Musina, a sub‐district bordering Zimbabwe, Medécins sans Frontières and the International Organization for Migration both implemented migration‐aware community‐based programmes that included the training of community‐based healthcare workers, to address these challenges. Using qualitative data, this paper explores the experiences that migrant farm workers, specifically those involved in the programmes, had of these interventions. A total of 79 semi‐structured interviews were completed with migrant farm workers, farm managers, NGO employees and civil servants between January 2017 and July 2018. These data were supplemented by a review of grey and published literature, as well as observation and field notes. Findings indicate that participants were primarily positive about the interventions. However, since the departure of both Medécins sans Frontières and the International Organization for Migration, community members have struggled to sustain the projects and the structural differences between the two programmes have created tensions. This paper highlights the ways in which local interventions that mobilise community members can improve the access that rural, migrant farming communities have to healthcare. However, it simultaneously points to the ways in which these interventions are unsustainable given the realities of non‐state interventions and the fragmented state approach to community‐based healthcare workers. The findings presented in this paper support global calls for the inclusion of migration and health in government policy making at all levels. However, findings also capture the limitations of community‐based interventions that do not recognise community‐based healthcare workers as social actors and fail to take into account their motivations, desires and need for continued supervision. As such, ensuring that the ways in which migration and health are included in policy making are sustainable emerges as a necessary element to be included in global calls.

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Home visiting programs for HIV-affected families: a comparison of service quality between volunteer-driven and paraprofessional models

Cited by 12 publications

References 17 publications

Community health worker support to improve HIV treatment outcomes for older children and adolescents in Zimbabwe: a process evaluation of the ZENITH trial

Community health worker support to improve HIV treatment outcomes for older children and adolescents in Zimbabwe: a process evaluation of the ZENITH trial

Factors associated with retention intentions among Isibindi child and youth care workers in South Africa: results from a national survey

Responding to the health needs of migrant farm workers in South Africa: Opportunities and challenges for sustainable community‐based responses

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