Abstract
The scale-up of HIV treatment programs in sub-Saharan Africa necessitates creative solutions that do not further burden the health system to meet global initiatives in prevention and care. This study assessed the work environment and impact of providing a behavioral risk reduction intervention in six community health centers (CHCs) in Lusaka, Zambia; opportunities and challenges to long-term program sustainability were identified. CHC staff participants (n = 82) were assessed on perceived clinic burden, job satisfaction, and burnout before and after implementation of the intervention. High levels of clinic burden were identified; however, no increase in perceived clinic burden or staff burnout was associated with providing the intervention. The intervention was sustained at the majority of CHCs and also adopted at additional clinics. Behavioral interventions can be successfully implemented and maintained in resource-poor settings. Creative strategies to overcome structural and economic challenges should be applied to enhance translation research.
Similar content being viewed by others
References
Foster N, McIntyre D. Economic Evaluation of task shifting approaches to the dispensing of anti-retroviral therapy. Hum Resour Heal. 2012; 10: 32.
Bhatt VR, Giri S, Koirala S. Health workforce shortage: A global crisis. The Internet Journal of World Health and Societal Politics. 2010; 7(1). http://www.ispub.com/journal/the-internet-journal-of-world-health-and-societal-politics/volume-7-number-1/health-workforce-shortage-a-global-crisis.html#sthash.HmyxVbvC.dpbs . Accessed January 18, 2013.
Kruse GR, Chapula BT, Ikeda S, et al. Burnout and use of HIV services among health care workers in Lusaka District, Zambia: a cross sectional study. Hum Resour Heal. 2009; 13: 7-55.
Zachariah R, Ford N, Philips M, et al. Task shifting in HIV/AIDS: opportunities, challenges, and proposed actions for sub-Saharan Africa. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009; 103: 549-558.
Morris M, Quiterio NM. Achieving and maintaining quality in HIV care: lessons learned from Zambia. In: Marlink RG, Teitelman ST, eds. From the Ground Up: Building Comprehensive HIV/AIDS Care Programs in Resource-Limited Settings. Washington, DC: Elizabeth Glaser Pediatric AIDS Foundation; 2009. http://ftguonline.org/ftgu-232/index.php/ftgu/article/view/1961/3918. Accessed January 22, 2013.
Zambia Country Report (2010). Monitoring the Declaration of Commitment on HIV and AIDS and the Universal Access: Biennial Report. Republic of Zambia Ministry of Health and National AIDS Council. Retrieved from http://data.unaids.org/pub/Report/2010/zambia_2010_country_progress_report_en.pdf. Accessed January 22, 2013.
Harris JB, Randels KM, Kancheya NG, Chapula BT, Reid S. Integration of TB and HIV care in large, urban primary health centers: lessons learned from Lusaka, Zambia. In: Marlink RG, Teitelman ST, eds. From the Ground Up: Building Comprehensive HIV/AIDS Care Programs in Resource-Limited Settings. Washington, DC: Elizabeth Glaser Pediatric AIDS Foundation; 2009. http://ftguonline.org/ftgu-232/index.php/ftgu/article/view/1994/3984. Accessed January 22, 2013.
WHO (2007a). Task shifting to tackle health worker shortages. HIV/AIDS Programme: strengthening health services to fight HIV/AIDS. http://www.who.int/healthsystems/task_shifting_booklet.pdf. Accessed January 22, 2013.
WHO (2007b). Task shifting: global recommendations and guidelines. Treat Train and Retrain. http://data.unaids.org/pub/Manual/2007/ttr_taskshifting_en.pdf. Accessed January 22, 2013.
WHO (2008). Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. http://www.who.int/healthsystems/TTR-TaskShifting.pdf. Accessed January 22, 2013.
USAID Health Policy Initiative. Creating an enabling environment for task shifting in HIV and AIDS services: recommendations based on two African country case studies. http://www.healthpolicyinitiative.com/Publications/Documents/1109_1_Task_Shifting_Summary_FINAL_05_06_10_acc.pdf. Published February 2010. Accessed January 24, 2013.
USAID Research and Evaluation Report. Task shifting in HIV/AIDS service delivery: an exploratory study of expert patients in Uganda. http://www.hciproject.org/sites/default/files/Uganda_Expert_Patients_Nov11.pdf. Published November 2011. Accessed January 24, 2013.
Nabudere H, Asiimwe D, Mijumbi R on behalf of the Regional East African Community Health (REACH), Uganda Task Shifting Working Group. An evidence-based policy brief (2010): Task shifting to optimize the roles of health workers to improve the delivery of maternal and child healthcare. http://www.unfpa.org/sowmy/resources/docs/library/R083_Nabudere_etal_2010_Uganda_HRHMNHJun10.pdf. Accessed January 24, 2013.
Born LJ, Wamulume C, Neroda KA, et al. Evaluation of task-shifting strategy involving peer educators in HIV care and treatment clinics in Lusaka, Zambia. J Public Health Africa. 2012; 2(3e): 8-14.
Sprague, C., and Black, V. (n.d.).Task shifting or task burden? Lay counselors and their impact on VCT service delivery and NSP goals. http://pdf.usaid.gov/pdf_docs/PNADS694.pdf. Accessed January 24, 2013.
Weiss SM, Jones DL, Lopez M, Villar-Loubet O, Chitalu N. The many faces of translational research: A tale of two studies. Transl Behav Med. 2011; 1(2): 327-330.
Townsend L, Mathews C, Zembe Y. A systematic review of behavioral interventions to prevent HIV infection and transmission among heterosexual, adult men in low- and middle-income countries. Prev Sci. 2013; 14: 88-105.
Saleh-Onoya D, Reddy PS, Ruiter RAC, Sifunda S, Wingood G, van den Borne B. Condom use promotion among isiXhosa speaking women living with HIV in the Western Cape Province, South Africa: a pilot study. AIDS Care. 2009; 21(7): 817-825.
Crepaz N, Lyles CM, Wolitski RJ, et al. Do prevention interventions reduce HIV risk behaviours among people living with HIV? A meta-analytic review of controlled trials. AIDS. 2006; 20(2): 143-157.
Nxumalo N, Goudge J, Thomas L. Outreach services to improve access to health care in South Africa: lessons from three community health worker programmes. Glob Health Action. 2013; 6: 19283.
Ndou T, van Zyl G, Hlahane S, Goudge J. A rapid assessment of a community health worker pilot programme to improve the management of hypertension and diabetes in Emfuleni sub-district of Gauteng Province, South Africa. Glob Health Action. 2013; 6: 19228.
Uwimana J, Zarowsky C, Hausler H, Jackson D. Training community care workers to provide comprehensive TB/HIV/PMTCT integrated care in KwaZulu-Natal: lessons learnt. Trop Med Int Health. 2012; 17: 488-496.
Peltzer K, Chao L-W, Dana P. Family planning among HIV positive and negative Prevention of Mother to Child (PMTCT) clients in a resource poor setting in South Africa. AIDS Behav. 2009; 13: 973-979.
Peltzer K, Tabane C, Matseke G, Simbayi L. Lay counsellor-based risk reduction intervention with HIV positive diagnosed patients at public HIV counselling and testing sites in Mpumalanga, South Africa. Evaluation and Program Planning. 2010; 33: 379-385.
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. 2012; 9: 218-226.
Swerissen H, Crisp BR. The sustainability of health promotion interventions for different levels of social organization. Health Promot Int. 2004; 19(1): 123-130.
Jones D, Weiss SM, Waldrop-Valverde D, Chitalu N, Mumbi M, Vamos S. Community-based risk reduction in Zambia. Open Health Services and Policy Journal. 2008; 1: 38-44.
Jones D, Weiss SM, Chitalu N, et al. Sexual risk reduction among Zambian couples. SAHARA. 2009; 6: 69-75.
Jones D, Villar-Loubet OM, Kankasa C, Chitalu N, Mumbi M, Weiss SM. Contraception and family planning among HIV seroconcordant and serodiscordant couples in the US and Zambia. Open Access Journal of Contraception. 2010; 1: 23-34.
Kelly JA, Somlaim AM, DiFranceisco WJ, et al. Bridging the gap between the science and service of HIV prevention: transferring effective research-based HIV prevention interventions to community AIDS service providers. Am J Public Health. 2000; 90(7): 1082-1088.
Kalichman SC, Rompa D, Cage M, et al. Effectiveness of an intervention to reduce HIV transmission risk in HIV-positive people. American Journal of Preventive Medicine. 2001; 21(2): 84-92.
Kalichman SC, Rompa D, Cage M. Group intervention to reduce HIV transmission risk behavior among persons living with HIV-AIDS. Behav Modif. 2005; 29(2): 256-285.
Jones D, Ross D, Weiss SM, Bhat G, Chitalu N, Bwalya V. Sexual risk reduction in Zambian HIV+women: NOW and Partner Projects. Annals of Behavioral Medicine. 2005; 29: 119.
Jones D, Ross D, Weiss SM, Bhat G, Chitalu N. Influence of partner participation on sexual risk behavior reduction among HIV-positive Zambian women. Journal of Urban Health. 2005; 82: 92-100.
Kristensen TS, Borritz M, Villadsen E, Christensen KB. The Copenhagen burnout inventory: a new tool for the assessment of burnout. Work & Stress: An International Journal of Work, Health & Organisations. 2005; 19(3): 192-207.
Spector PE. Measurement of human service staff satisfaction: development of the Job Satisfaction Survey. American Journal of Community Psychology. 1985; 13: 693-713.
Callaghan M, Ford N, Schneider H. A systemic review of task-shifting for HIV treatment and care in Africa. Hum Resour Heal. 2010; 8: 8.
Ferrinho P, Sidat M, Goma F, Dussault G. Task-shifting: Experiences and opinions of health workers in Mozambique and Zambia. Hum Resour Heal. 2012; 10: 34.
Munga MA, Kilima SP, Mutalemwa PP, Kisoka WJ, Malacela MN. Experiences, opportunities, and challenges of implementing task shifting in underserved remote settings: the case of Kongwa District, central Tanzania. BMC International Health and Human Rights. 2012; 12: 27.
Vermund SH, Sidat M, Weil LF, Tique JA, Moon TD, Ciampa PJ. Transitioning HIV care and treatment programs in southern Africa to full local management. AIDS. 2012; 26(10): 1303-1.
Acknowledgments
This study was supported by the University of Miami Miller School of Medicine and the University of Zambia School of Medicine which is funded by a grant (5R01HD058481) from the National Institute of Health (NIH).
Author information
Authors and Affiliations
Corresponding author
Additional information
Implications
Policy: Behavioral interventions should be integrated into the existing health delivery system as an essential component of HIV prevention packages.
Research: Future translational research should include the development of strategies to implement large-scale prevention initiatives in community health clinics that do not add to clinic burden.
Practice: Creative strategies to overcome structural and economic challenges, such as the train-the-trainer model, may be utilized to successfully implement interventions.
About this article
Cite this article
Vamos, S., Mumbi, M., Cook, R. et al. Translation and sustainability of an HIV prevention intervention in Lusaka, Zambia. Behav. Med. Pract. Policy Res. 4, 141–148 (2014). https://doi.org/10.1007/s13142-013-0237-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13142-013-0237-9