Impact of youth lay health workers on HIV service delivery in South Africa: A pragmatic cluster randomized trial of the Youth Health Africa program.
<h4>Background</h4>Innovative approaches are needed to increase lay health workers in HIV programs. The Youth Health Africa (YHA) program is a novel approach that places young adults seeking work experience in one-year internships in health facilities to support HIV-related programming (...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2023-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0294719&type=printable |
| _version_ | 1797366559419662336 |
|---|---|
| author | Deanna Tollefson Sayan Dasgupta Geoffrey Setswe Sarah Reeves Salome Charalambous Ann Duerr |
| author_facet | Deanna Tollefson Sayan Dasgupta Geoffrey Setswe Sarah Reeves Salome Charalambous Ann Duerr |
| author_sort | Deanna Tollefson |
| collection | DOAJ |
| description | <h4>Background</h4>Innovative approaches are needed to increase lay health workers in HIV programs. The Youth Health Africa (YHA) program is a novel approach that places young adults seeking work experience in one-year internships in health facilities to support HIV-related programming (e.g., HIV testing) or administration (e.g., filing).<h4>Methods</h4>We implemented a pragmatic, randomized trial among 20 facilities in Ngaka Modiri Molema district in North West province from October 2020-August 2021 to assess impact of YHA interns on HIV testing, treatment initiation, and retention in care. The primary outcome was proportion of patients tested for HIV. Secondary outcomes assessed HIV positivity, initiation in care, retention in care, and HIV testing among males and adolescents/young adults. We conducted an intention-to-treat analysis accounting for variations in baseline outcomes between control and intervention facilities using difference-in-difference and controlled time series approaches. We repeated this using as-treated groupings for sensitivity analyses.<h4>Results</h4>Fifty interns were placed in 20 facilities; thirty-four interns remained at 18 facilities through August 2021. Compared to control facilities, intervention facilities had a greater improvement in HIV testing (ΔΔ+5.7%, 95% Confidence Interval (CI): -3.7%-15.1%) and treatment initiation (ΔΔ+10.3%, 95% CI: -27.8-48.5%), but these differences were not statistically significant. There was an immediate increase in HIV testing in intervention facilities after program interns were placed, which was not observed in control facilities; this difference was significant (ΔΔ+8.4%, 95% CI: 0.5-16.4%, p = 0.036). There were no other differences in outcomes observed between intervention and control facilities.<h4>Conclusion</h4>This was largely a null trial, but there were signals that program interns may have positive impact on HIV testing and treatment initiation. As implemented in this study, addition of YHA program interns had little impact on facility-based HIV service delivery. A higher number of interns placed per facility may be necessary to affect HIV services.<h4>Trial registration</h4>Registration: This trial was registered with the ISRCTN (Registration number: ISRCTN67031403) in October 2022. |
| first_indexed | 2024-03-08T17:05:30Z |
| format | Article |
| id | doaj.art-fd41a1e3f69a4b56bc9eaa6507bfc1df |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-08T17:05:30Z |
| publishDate | 2023-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-fd41a1e3f69a4b56bc9eaa6507bfc1df2024-01-04T05:31:42ZengPublic Library of Science (PLoS)PLoS ONE1932-62032023-01-011811e029471910.1371/journal.pone.0294719Impact of youth lay health workers on HIV service delivery in South Africa: A pragmatic cluster randomized trial of the Youth Health Africa program.Deanna TollefsonSayan DasguptaGeoffrey SetsweSarah ReevesSalome CharalambousAnn Duerr<h4>Background</h4>Innovative approaches are needed to increase lay health workers in HIV programs. The Youth Health Africa (YHA) program is a novel approach that places young adults seeking work experience in one-year internships in health facilities to support HIV-related programming (e.g., HIV testing) or administration (e.g., filing).<h4>Methods</h4>We implemented a pragmatic, randomized trial among 20 facilities in Ngaka Modiri Molema district in North West province from October 2020-August 2021 to assess impact of YHA interns on HIV testing, treatment initiation, and retention in care. The primary outcome was proportion of patients tested for HIV. Secondary outcomes assessed HIV positivity, initiation in care, retention in care, and HIV testing among males and adolescents/young adults. We conducted an intention-to-treat analysis accounting for variations in baseline outcomes between control and intervention facilities using difference-in-difference and controlled time series approaches. We repeated this using as-treated groupings for sensitivity analyses.<h4>Results</h4>Fifty interns were placed in 20 facilities; thirty-four interns remained at 18 facilities through August 2021. Compared to control facilities, intervention facilities had a greater improvement in HIV testing (ΔΔ+5.7%, 95% Confidence Interval (CI): -3.7%-15.1%) and treatment initiation (ΔΔ+10.3%, 95% CI: -27.8-48.5%), but these differences were not statistically significant. There was an immediate increase in HIV testing in intervention facilities after program interns were placed, which was not observed in control facilities; this difference was significant (ΔΔ+8.4%, 95% CI: 0.5-16.4%, p = 0.036). There were no other differences in outcomes observed between intervention and control facilities.<h4>Conclusion</h4>This was largely a null trial, but there were signals that program interns may have positive impact on HIV testing and treatment initiation. As implemented in this study, addition of YHA program interns had little impact on facility-based HIV service delivery. A higher number of interns placed per facility may be necessary to affect HIV services.<h4>Trial registration</h4>Registration: This trial was registered with the ISRCTN (Registration number: ISRCTN67031403) in October 2022.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0294719&type=printable |
| spellingShingle | Deanna Tollefson Sayan Dasgupta Geoffrey Setswe Sarah Reeves Salome Charalambous Ann Duerr Impact of youth lay health workers on HIV service delivery in South Africa: A pragmatic cluster randomized trial of the Youth Health Africa program. PLoS ONE |
| title | Impact of youth lay health workers on HIV service delivery in South Africa: A pragmatic cluster randomized trial of the Youth Health Africa program. |
| title_full | Impact of youth lay health workers on HIV service delivery in South Africa: A pragmatic cluster randomized trial of the Youth Health Africa program. |
| title_fullStr | Impact of youth lay health workers on HIV service delivery in South Africa: A pragmatic cluster randomized trial of the Youth Health Africa program. |
| title_full_unstemmed | Impact of youth lay health workers on HIV service delivery in South Africa: A pragmatic cluster randomized trial of the Youth Health Africa program. |
| title_short | Impact of youth lay health workers on HIV service delivery in South Africa: A pragmatic cluster randomized trial of the Youth Health Africa program. |
| title_sort | impact of youth lay health workers on hiv service delivery in south africa a pragmatic cluster randomized trial of the youth health africa program |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0294719&type=printable |
| work_keys_str_mv | AT deannatollefson impactofyouthlayhealthworkersonhivservicedeliveryinsouthafricaapragmaticclusterrandomizedtrialoftheyouthhealthafricaprogram AT sayandasgupta impactofyouthlayhealthworkersonhivservicedeliveryinsouthafricaapragmaticclusterrandomizedtrialoftheyouthhealthafricaprogram AT geoffreysetswe impactofyouthlayhealthworkersonhivservicedeliveryinsouthafricaapragmaticclusterrandomizedtrialoftheyouthhealthafricaprogram AT sarahreeves impactofyouthlayhealthworkersonhivservicedeliveryinsouthafricaapragmaticclusterrandomizedtrialoftheyouthhealthafricaprogram AT salomecharalambous impactofyouthlayhealthworkersonhivservicedeliveryinsouthafricaapragmaticclusterrandomizedtrialoftheyouthhealthafricaprogram AT annduerr impactofyouthlayhealthworkersonhivservicedeliveryinsouthafricaapragmaticclusterrandomizedtrialoftheyouthhealthafricaprogram |