TY - JOUR
T1 - Qualitative insights into implementation, processes, and outcomes of a randomized trial on peer support and HIV care engagement in Rakai, Uganda
AU - Monroe, April
AU - Nakigozi, Gertrude
AU - Ddaaki, William
AU - Bazaale, Jeremiah Mulamba
AU - Gray, Ronald H.
AU - Wawer, Maria J.
AU - Reynolds, Steven J.
AU - Kennedy, Caitlin E.
AU - Chang, Larry W.
N1 - Funding Information:
This study was supported by The National Institute of Mental Health, National Institutes of Health (K23MH086338), the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institute of Health, and the Johns Hopkins University Center for AIDS Research (P30AI094189).
Publisher Copyright:
© 2017 The Author(s).
PY - 2017/1/10
Y1 - 2017/1/10
N2 - Background: People living with human immunodeficiency virus (HIV) who have not yet initiated antiretroviral therapy (ART) can benefit from being engaged in care and utilizing preventive interventions. Community-based peer support may be an effective approach to promote these important HIV services. Methods: After conducting a randomized trial of the impact of peer support on pre-ART outcomes, we conducted a qualitative evaluation to better understand trial implementation, processes, and results. Overall, 75 participants, including trial participants (clients), peer supporters, and clinic staff, participated in 41 in-depth interviews and 6 focus group discussions. A situated Information Motivation, and Behavioral skills model of behavior change was used to develop semi-structured interview and focus group guides. Transcripts were coded and thematically synthesized. Results: We found that participant narratives were generally consistent with the theoretical model, indicating that peer support improved information, motivation, and behavioral skills, leading to increased engagement in pre-ART care. Clients described how peer supporters reinforced health messages and helped them better understand complicated health information. Peer supporters also helped clients navigate the health system, develop support networks, and identify strategies for remembering medication and clinic appointments. Some peer supporters adopted roles beyond visiting patients, serving as a bridge between the client and his or her family, community, and health system. Qualitative results demonstrated plausible processes by which peer support improved client engagement in care, cotrimoxazole use, and safe water vessel use. Challenges identified included insufficient messaging surrounding ART initiation, lack of care continuity after ART initiation, rare breaches in confidentiality, and structural challenges. Conclusions: The evaluation found largely positive perceptions of the peer intervention across stakeholders and provided valuable information to inform uptake and scalability of the intervention. Study findings also suggest several areas for improvement for future implementation of pre-ART peer support programs. Trial registration:NCT01366690. Registered June 2, 2011.
AB - Background: People living with human immunodeficiency virus (HIV) who have not yet initiated antiretroviral therapy (ART) can benefit from being engaged in care and utilizing preventive interventions. Community-based peer support may be an effective approach to promote these important HIV services. Methods: After conducting a randomized trial of the impact of peer support on pre-ART outcomes, we conducted a qualitative evaluation to better understand trial implementation, processes, and results. Overall, 75 participants, including trial participants (clients), peer supporters, and clinic staff, participated in 41 in-depth interviews and 6 focus group discussions. A situated Information Motivation, and Behavioral skills model of behavior change was used to develop semi-structured interview and focus group guides. Transcripts were coded and thematically synthesized. Results: We found that participant narratives were generally consistent with the theoretical model, indicating that peer support improved information, motivation, and behavioral skills, leading to increased engagement in pre-ART care. Clients described how peer supporters reinforced health messages and helped them better understand complicated health information. Peer supporters also helped clients navigate the health system, develop support networks, and identify strategies for remembering medication and clinic appointments. Some peer supporters adopted roles beyond visiting patients, serving as a bridge between the client and his or her family, community, and health system. Qualitative results demonstrated plausible processes by which peer support improved client engagement in care, cotrimoxazole use, and safe water vessel use. Challenges identified included insufficient messaging surrounding ART initiation, lack of care continuity after ART initiation, rare breaches in confidentiality, and structural challenges. Conclusions: The evaluation found largely positive perceptions of the peer intervention across stakeholders and provided valuable information to inform uptake and scalability of the intervention. Study findings also suggest several areas for improvement for future implementation of pre-ART peer support programs. Trial registration:NCT01366690. Registered June 2, 2011.
KW - HIV
KW - Implementation science
KW - Linkage
KW - Mixed methods research
KW - Peer support
KW - Pre-ART
KW - Qualitative research
KW - Randomized controlled trial
KW - Uganda
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U2 - 10.1186/s12879-016-2156-0
DO - 10.1186/s12879-016-2156-0
M3 - Article
C2 - 28068935
AN - SCOPUS:85008439829
SN - 1471-2334
VL - 17
JO - BMC infectious diseases
JF - BMC infectious diseases
IS - 1
M1 - 54
ER -