The Role of Community Health Workers in HIV Care Engagement: A Qualitative Study of Stakeholder Perspectives in Tanzania.
Brandon A Knettel, Kimberly M Fernandez, Lisa Wanda and 5 others
PMID 33908407WHAT IT FOUND
Patients and nurses described community health workers as trusted support for HIV care, but seven of 18 patients were never introduced, three declined because of stigma, and seven had regular contact.
Nurses saw them easing workload when linkage and supervision worked.
Key findings
01Seven of 18 patients were never informed of the program, and among the 11 introduced, three declined and seven reported regular contact with a community health worker.
02Nurses generally valued community health workers for tracking patients and supporting education, but two of eight nurses said poor communication and supervision left them doing all the work.
03Community health workers had only a 6-week initial curriculum and no ongoing training, and almost all said they needed refresher training to better support HIV treatment.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study interviewed people at two clinics in one region, so it cannot describe all CBHS sites or other settings. It reports perceptions and experiences, not a measured effect of community health workers on HIV care engagement or adherence. Patients were recruited only after initiating HIV care, so it missed people who never started care or had already fallen out. Three of the 18 patients were lost to follow-up in the record review, but the study did not analyze retention as an outcome. Stakeholders included program administrators, nurses, and community health workers, so responses may have been shaped by loyalty, workload pressures, or social desirability. With 18 patients, the findings cannot be generalized.
Declared interests
The authors reported no real or perceived vested interests. The article is labelled as NIH extramural research support, but the supplied text does not state the funder's role.
The easy way to misread this
Do not read this as evidence that community health workers improve HIV care engagement. The study reports stakeholder perceptions and program experiences, not a tested intervention outcome, and seven of 18 patients were never introduced, while three declined because of stigma and privacy concerns.