Novel community health worker strategy for HIV service engagement in a hyperendemic community in Rakai, Uganda: A pragmatic, cluster-randomized trial

Larry W Chang, Ismail Mbabali, Heidi Hutton, K Rivet Amico, Xiangrong Kong, Jeremiah Mulamba, Aggrey Anok, Joseph Ssekasanvu, Amanda Long, Alvin G Thomas, Kristin Thomas, Eva Bugos, Rose Pollard, Kimiko van Wickle, Caitlin E Kennedy, Fred Nalugoda, David Serwadda, Robert C Bollinger, Thomas C Quinn, Steven J Reynolds, Ronald H Gray, Maria J Wawer and Gertrude Nakigozi

PLOS Medicine, 2021, vol. 18, issue 1, 1-14

Abstract: Background: Effective implementation strategies are needed to increase engagement in HIV services in hyperendemic settings. We conducted a pragmatic cluster-randomized trial in a high-risk, highly mobile fishing community (HIV prevalence: approximately 38%) in Rakai, Uganda, to assess the impact of a community health worker-delivered, theory-based (situated Information, Motivation, and Behavior Skills), motivational interviewing-informed, and mobile phone application-supported counseling strategy called “Health Scouts” to promote engagement in HIV treatment and prevention services. Methods and findings: The study community was divided into 40 contiguous, randomly allocated clusters (20 intervention clusters, n = 1,054 participants at baseline; 20 control clusters, n = 1,094 participants at baseline). From September 2015 to December 2018, the Health Scouts were deployed in intervention clusters. Community-wide, cross-sectional surveys of consenting 15 to 49-year-old residents were conducted at approximately 15 months (mid-study) and at approximately 39 months (end-study) assessing the primary programmatic outcomes of self-reported linkage to HIV care, antiretroviral therapy (ART) use, and male circumcision, and the primary biologic outcome of HIV viral suppression (

Date: 2021
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pmed00:1003475

DOI: 10.1371/journal.pmed.1003475

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