Provision of HIV services by community health workers should be strengthened to achieve full programme potential: a cross‐sectional analysis in rural South Africa

OBJECTIF: Les agents de sante communautaires (ASC) d'Afrique du Sud constituent un pont entre les etablissements de soins de sante primaires et leur communaute. Nous avons effectue une analyse transversale pour determiner la contribution du programme VIH base sur la communaute (PVBC) au programme global de lutte contre le VIH. METHODES: Nous avons collecte des donnees sur la prestation de services a partir du registre des activites quotidiennes des ASC rattaches a 12 etablissements de soins de sante primaires dans le district rural de Mopani, en Afrique du Sud. Les identifiants individuels des personnes referees vers l’etablissement pour des services VIH ont ete enregistres et verifies par rapport aux registres de routine des patients de l’etablissement afin de determiner l'efficacite de l'aiguillage. RESULTATS: Les services VIH ont ete fournis dans 18.927 occasions; 30% du total des activites realisees par les ASC au cours de la periode d’etude. Les ASC ont evalue 12.159 personnes pour les risques du VIH (couverture de 13% de la population etudiee); seuls 290 (2%) ont ete referes pour des services de depistage du VIH. L'aiguillage a ete efficace chez 213 personnes (73%). L’evidence de seropositivite a ete trouvee chez 38 personnes (18%). Cependant, 30 (79%) de ces personnes ont ete referees par des ASC alors qu'elles etaient sous ART. Un soutien a la compliance a ete fourni au cours de 5.657 visites; un seul individu a ete refere pour des complications. Enfin, sur 864 personnes perdues du programme ART, les ASC ont reussi a retrouver 452 (52%) pour les referer de nouveau a l’etablissement; seuls 241 (53%) de celles-ci ont ete (re) initiees sous ART. METHODS: We collected service provision data from the daily activity register of CHWs attached to 12 PHC facilities in rural Mopani District, South Africa. Personal identifiers of individuals referred to the facility for HIV services were recorded and verified against facility routine patient registers to determine the effectiveness of referral. RESULTS: HIV services were provided on 18 927 occasions; 30% of the total activities performed by CHWs during the study period. CHWs assessed 12 159 individuals for HIV risk (13% coverage of the study population); only 290 (2%) were referred for HIV testing services. Referral was effective in 213 (73%) individuals; evidence of an HIV-positive status was found for 38 (18%) individuals. However, 30 (79%) of these individuals were referred by CHWs despite being on ART. Adherence support was provided during 5657 visits; only one individual was referred for complications. Finally, of the 864 individuals lost to the ART programme, CHWs managed to find 452 (52%) for referral back to the facility; only 241 (53%) of these were (re)initiated on ART. CONCLUSIONS: Provision of HIV services by CHWs should be strengthened to fully deliver on the programme's potential. Human resource investment, home-based HIV testing and improved tracing models constitute potential strategies to enhance CHWs impact on the HIV programme.