Patient- and delivery-level factors related to acceptance of HIV counseling and testing services among tuberculosis patients in South Africa: a qualitative study with community health workers and program managers

Heunis, Julia; Wouters, Edwin; Norton, Wynne E.; Engelbrecht, Michelle; Kigozi, N. Gladys; Sharma, Anjali; Ragin, Camille

doi:10.1186/1748-5908-6-27

Cited by 43 publications

(35 citation statements)

References 21 publications

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“…In South Africa, both adults and adolescents are at high HIV risk, yet adults are reluctant to attend prevention programs or to get tested due to associated high stigma. 36,37 A program for parents can help to de-stigmatize HIV by focusing parents on the need to protect their children, while simultaneously educating parents.…”

Section: Discussionmentioning

confidence: 99%

Let's Talk!, A South African Worksite-Based HIV Prevention Parenting Program

Bogart

Skinner

Thurston

et al. 2013

Journal of Adolescent Health

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Purpose South African adolescents have high HIV risk, yet few prevention interventions are effective. Parents play a pivotal role in youths’ healthy sexual development and may be at-risk themselves. We tested whether Let’s Talk!, a worksite-based parenting program, improves parent-child communication about HIV and sexual health, and parent condom use self-efficacy and behavior. Methods We culturally adapted Let’s Talk! in two languages, drawing on formative research and community stakeholder input. We then conducted a small randomized test at a large public worksite in Cape Town. The intervention consisted of five weekly two-hour group sessions for parents of youth aged 11–15. Sixty-six parents [64% female] and their 64 adolescents [41% female] completed surveys before and 1–2 weeks post-intervention; surveys assessed comfort with talking about sex, communication about 16 HIV- and sex-related topics, and parents’ condom use self-efficacy and behavior. Thirty-four Black-African (Xhosa-language) and 32 Coloured (mixed-race; Afrikaans-language) parent-child dyads participated. Parents were randomized to intervention (n=34) and control (n=32) groups; randomization was stratified by language. Results Multivariate regressions indicated that the intervention significantly increased parents’ comfort with talking to their adolescent about sex, b(SE)=0.98(0.39), p=0.02, and the number of sex- and HIV-related topics discussed with their adolescent, b(SE)=3.26(1.12), p=0.005. Compared to control parents, intervention parents were more likely to discuss new sex- and HIV-related topics not discussed before the intervention, b(SE)=2.85(0.80), p<.001. The intervention significantly increased parents’ self-efficacy for condom use, b(SE)=0.60(0.21), p=0.007. Conclusions Let’s Talk! holds promise for improving parent-child communication, a critical first step in preventing HIV among youth.

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Section: Discussionmentioning

confidence: 99%

Let's Talk!, A South African Worksite-Based HIV Prevention Parenting Program

Bogart

Skinner

Thurston

et al. 2013

Journal of Adolescent Health

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“…There is some evidence that CHWs’ personal beliefs about health, their working conditions, their interactions with health professionals, and perceptions about CHWs by both community members and policy makers, all directly impact the effectiveness of programs and policies that utilize CHWs for task-sharing. [16–19]…”

Section: Introductionmentioning

confidence: 99%

The Training and Fieldwork Experiences of Community Health Workers Conducting Population-Based, Noninvasive Screening for CVD in LMIC

Abrahams‐Gessel¹,

Denman

Montano

et al. 2015

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Background Cardiovascular disease (CVD) is on the rise in low- and middle-income countries (LMIC) and is proving difficult to combat due to the emphasis on improving outcomes in maternal and child health and infectious diseases, against a backdrop of severe human resource and infrastructure constraints. Effective task-sharing from physicians or nurses to community health workers (CHWs) to conduct population-based screening for persons at risk, has the potential to mitigate the impact of CVD on vulnerable populations. CHWs in Bangladesh, Guatemala, Mexico, and South Africa were trained to conduct non-invasive population-based screening for persons at high risk for CVD. Objective (s) The objectives of this study were to quantitatively assess the performance of CHWs during training and to qualitatively capture their training and fieldwork experiences while conducting non-invasive screening for cardiovascular disease (CVD) risk in their communities. Methods Written tests were used to assess CHWs’ acquisition of content knowledge during training, and focus group discussions conducted to capture their training and fieldwork experiences. Results Training was effective at increasing the CHWs’ content knowledge of cardiovascular disease (CVD) and this knowledge was largely retained up to six months after the completion of field work. Common themes which need to be addressed when designing task sharing with CHWs in chronic diseases are identified, including language, respect, and compensation. The importance of having intimate knowledge of the community receiving services from design to implementation is underscored. Conclusions Effective training for screening for CVD in community settings should have a strong didactic core that is supplemented with culture-specific adaptations in the delivery of instruction. The incorporation of expert and intimate knowledge of the communities themselves is critical, from the design to implementation phases of training. Challenges such as role definition, defining career paths, and providing adequate remuneration, must be addressed.

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“…The aims of this strategy included 1) increasing HIV testing among TB patients by promoting a patient-centered approach in which CHWs provided non-invasive testing and communication of results during the same encounter; 2) taskshifting testing to CHWs to relieve clinic-based health professionals of this function; and 3) providing accompaniment to those diagnosed with HIV to ensure confirmatory testing, facilitating disclosure and assisting with the establishment of HIV care. 16 To our knowledge, this is the first study in a resource-poor setting using CHWs to perform communitybased rapid HIV testing to TB patients.…”

Section: Introductionmentioning

confidence: 99%

“…Delivery-related factors included staff shortages and high workload, and poor infrastructure to encourage testing and address barriers. 16 A study in Uganda using qualitative data from patients and providers described the following barriers to universal HIV testing for TB patients: poor TB-HIV planning, coordination and leadership; inadequate provider knowledge, limited TB-HIV inter-clinic referral; high costs of services; and provider shortages amidst high patient loads. 17 Aversion to traditional HIV testing caused by invasiveness of blood draws, fears of needles and/or blood, and lack of same-day results also negatively influence a person's decision to be tested.…”

Section: Introductionmentioning

confidence: 99%

“…A recent study based on interviews with community health workers (CHWs) and program managers in the Free State Province of South Africa, where testing of TB patients was low (46%) despite a 73% co-infection rate, identified individual factors and delivery-related factors. 16 Individual factors included fear of HIV/acquired immunodeficiency syndrome (AIDS), TB-HIV co-infection, death, stigma, and perceived lack of confidentiality of HIV test results as impeding factors to testing. Delivery-related factors included staff shortages and high workload, and poor infrastructure to encourage testing and address barriers.…”

Section: Introductionmentioning

confidence: 99%

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