Community health worker interventions to promote psychosocial outcomes among people living with HIV-A systematic review

Hae-Ra Han, Kyounghae Kim, Jeanne Murphy, Joycelyn Cudjoe, Patty Wilson, Phyllis Sharps, Jason E Farley, Hae-Ra Han, Kyounghae Kim, Jeanne Murphy, Joycelyn Cudjoe, Patty Wilson, Phyllis Sharps, Jason E Farley

Abstract

Background: Community health worker (CHW) interventions are a successful strategy to promote health among HIV-negative and persons living with HIV (PLWH). Psychosocial factors are critical dimensions of HIV/AIDS care contributing to prognosis of the disease, yet it is unclear how CHW interventions improve psychosocial outcomes in PLWH. The purpose of this study was to critically appraise the types, scope, and nature of CHW interventions designed to address psychosocial outcomes in PLWH.

Methods: We performed database searches-PubMed, EMBASE, CINAHL, and Cochrane-to identify randomized controlled trials published in English before April 2017. Fourteen articles met the eligibility criteria.

Results: Half of the studies were conducted in the United States. Social cognitive theory was used more than once in nine theory-guided studies. CHW interventions were largely focused on reducing depression (n = 6) or stigma related to HIV (n = 4), or promoting quality of life (n = 4), social support (n = 4), and self-efficacy (n = 4). Didactic methods and role-playing were used to train CHWs. CHWs played multiple roles in delivering intervention, including a counselor and a supporter (n = 10), educator (n = 5), or a navigator (n = 3). CHW intervention fidelity was assessed in 4 studies. Five studies found positive changes in six psychosocial outcomes including quality of life (2 of 4) and self-efficacy (2 of 4). CHW interventions had no effect on social support in 2 of 4 studies, and stigma in 3 of 4 studies. None of the CHW interventions were successful in reducing depressive symptoms among PLWH.

Conclusions: Evidence partially supported the use of CHWs in promoting psychosocial outcomes in PLWH. Future CHW intervention should be expanded in scope to address key psychosocial determinants of HIV/AIDS outcomes such as health literacy. Further, fidelity measures should be incorporated into intervention delivery.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Review and selection process.
Fig 1. Review and selection process.
Fig 2. Methodological quality ratings of included…
Fig 2. Methodological quality ratings of included studies.

References

    1. Giblin PT. Effective utilization and evaluation of indigenous health care workers. Public health reports (Washington, DC: 1974). 1989;104(4):361–8. ; PubMed Central PMCID: PMC1579943.
    1. Kim K, Choi JS, Choi E, Nieman CL, Joo JH, Lin FR, et al. Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review. Am J Public Health. 2016;106(4):e3–e28. doi: ; PubMed Central PMCID: PMC4785041.
    1. Mwai GW, Mburu G, Torpey K, Frost P, Ford N, Seeley J. Role and outcomes of community health workers in HIV care in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013;16:18586 doi: ; PubMed Central PMCID: PMC3772323.
    1. DePue JD, Dunsiger S, Seiden AD, Blume J, Rosen RK, Goldstein MG et al. Nurse–community health worker team improves diabetes care in American Samoa: results of a randomized controlled trial. Diabetes Care. 2013;36(7):1947–1953. doi: .
    1. Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet. 2008;372(9642):902–9. doi:
    1. World Health Organization. Will we achieve universal access to HIV/AIDS services with the health workforce we have? A snapshot from five countries: Literature review. Available from
    1. World Health Organization. Psychosocial support. Available from
    1. Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8. .
    1. Cange CW, LeBreton M, Billong S, Saylors K, Tamoufe U, Papworth E, et al. Influence of stigma and homophobia on mental health and on the uptake of HIV/sexually transmissible infection services for Cameroonian men who have sex with men. Sexual health. 2015;12(4):315–21. Epub 2015/06/29. doi: .
    1. Coleman LM, Ford NJ. An extensive literature review of the evaluation of HIV prevention programmes. Health education research. 1996;11(3):327–38. .
    1. Ambia J, Mandala J. A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention. Journal of the International AIDS Society. 2016;19(1):20309 doi: ; PubMed Central PMCID: PMC4824870.
    1. Sharma M, Ying R, Tarr G, Barnabas R. Systematic review and meta-analysis of community and facility-based HIV testing to address linkage to care gaps in sub-Saharan Africa. Nature. 2015;528(7580):S77–85. doi: ; PubMed Central PMCID: PMC4778960.
    1. Kenya S, Chida N, Symes S, Shor-Posner G. Can community health workers improve adherence to highly active antiretroviral therapy in the USA? A review of the literature. HIV medicine. 2011;12(9):525–34. doi: .
    1. Martikainen P, Bartley M, Lahelma E. Psychosocial determinants of health in social epidemiology. Int J Epidemiol. 2002;31(6):1091–3. .
    1. Oxford English Dictionary. Available from: .
    1. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed). 2011;343:d5928 doi: ; PubMed Central PMCID: PMC3196245.
    1. DeMarco RF, Chan K. The Sistah Powah structured writing intervention: a feasibility study for aging, low-income, HIV-positive Black women. American journal of health promotion: AJHP. 2013;28(2):108–18. Epub 2013/04/30. doi: .
    1. Fogarty LA, Heilig CM, Armstrong K, Cabral R, Galavotti C, Gielen AC, et al. Long-term effectiveness of a peer-based intervention to promote condom and contraceptive use among HIV-positive and at-risk women. Public health reports (Washington, DC: 1974) [Internet]. 2001; 116 Suppl 1:[103–19 pp.]. Available from: .
    1. Gifford AL, Laurent DD, Gonzales VM, Chesney MA, Lorig KR. Pilot randomized trial of education to improve self-management skills of men with symptomatic HIV/AIDS. Journal of acquired immune deficiency syndromes and human retrovirology: official publication of the International Retrovirology Association. 1998;18(2):136–44. .
    1. Parker R, Jelsma J, Stein DJ. Managing Pain in Women Living With HIV/AIDS: A Randomized Controlled Trial Testing the Effect of a Six-Week Peer-Led Exercise and Education Intervention. J Nerv Ment Dis. 2016;204(9):665–72. doi: .
    1. Simoni JM, Pantalone DW, Plummer MD, Huang B. A randomized controlled trial of a peer support intervention targeting antiretroviral medication adherence and depressive symptomatology in HIV-positive men and women. Health psychology: official journal of the Division of Health Psychology, American Psychological Association [Internet]. 2007; 26(4):[488–95 pp.]. Available from: .
    1. Velasquez MM, von Sternberg K, Johnson DH, Green C, Carbonari JP, Parsons JT. Reducing sexual risk behaviors and alcohol use among HIV-positive men who have sex with men: a randomized clinical trial. Journal of consulting and clinical psychology. 2009;77(4):657–67. doi: ; PubMed Central PMCID: PMC3737491.
    1. Webel AR. Testing a peer-based symptom management intervention for women living with HIV/AIDS. AIDS care [Internet]. 2010; 22(9):[1029–40 pp.]. Available from: . doi:
    1. Van Tam V, Larsson M, Pharris A, Diedrichs B, Nguyen HP, Nguyen CTK, et al. Peer support and improved quality of life among persons living with HIV on antiretroviral treatment: A randomised controlled trial from north-eastern Vietnam. Health and quality of life outcomes. 2012;10.
    1. Peltzer K, Ramlagan S, Jones D, Weiss SM, Fomundam H, Chanetsa L. Efficacy of a lay health worker led group antiretroviral medication adherence training among non-adherent HIV-positive patients in KwaZulu-Natal, South Africa: results from a randomized trial. SAHARA J: journal of Social Aspects of HIV/AIDS Research Alliance [Internet]. 2012; 9(4):[218–26 pp.]. Available from: .
    1. Robbins RN, Mellins CA, Leu CS, Rowe J, Warne P, Abrams EJ, et al. Enhancing Lay Counselor Capacity to Improve Patient Outcomes with Multimedia Technology. AIDS and behavior. 2015;19 Suppl 2:163–76. Epub 2015/01/09. doi: ; PubMed Central PMCID: PMC4537057.
    1. Molassiotis A, Callaghan P, Twinn SF, Lam SW, Chung WY, Li CK. A pilot study of the effects of cognitive-behavioral group therapy and peer support/counseling in decreasing psychologic distress and improving quality of life in Chinese patients with symptomatic HIV disease. AIDS patient care and STDs [Internet]. 2002; 16(2):[83–96 pp.]. Available from: . doi:
    1. Enriquez M, Cheng AL, Banderas J, Farnan R, Chertoff K, Hayes D, et al. A Peer-Led HIV Medication Adherence Intervention Targeting Adults Linked to Medical Care but without a Suppressed Viral Load. Journal of the International Association of Providers of AIDS Care. 2015;14(5):441–8. Epub 2014/11/22. doi: .
    1. Masquillier C, Wouters E, Mortelmans D, Roux Booysen F. Families as catalysts for peer adherence support in enhancing hope for people living with HIV/AIDS in South Africa. Journal of the International AIDS Society [Internet]. 2014; 17 Available from: .
    1. Masquillier C, Wouters E, Mortelmans D, le Roux Booysen F. The impact of community support initiatives on the stigma experienced by people living with HIV/AIDS in South Africa. AIDS and behavior. 2015;19(2):214–26. doi: .
    1. Cunha GH, Galvão MT, Pinheiro PN, Vieira NF. Health literacy for people living with HIV/AIDS: an integrative review. Rev Bras Enferm. 2017;70(1):180–188. doi: .

Source: PubMed

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