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Impact of Community Support Workers in Rural Ethiopia on Emotional and Psychosocial Health of Persons Living with HIV: Results of a Three-Year Randomized Community Trial

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Abstract

People living with HIV face multiple psychosocial challenges. In a large, predominantly rural Ethiopian region, 1799 HIV patients new to care were enrolled from 32 sites in a cluster randomized trial using trained community support workers with HIV to provide individual health education, counseling and social support. Participants received annual surveys through 36 months using items drawn from the Centre for Epidemiologic Studies Depression Scale-10, Medical Outcome Study Social Support Survey, and HIV/AIDS Stigma Instrument-PLWA. At 12 months (using linear mixed effects regression models controlling for enrollment site clustering), intervention participants had greater emotional/informational and tangible assistance social support scores, and lower scores assessing depression symptoms and negative self-perception due to HIV status. A significant treatment effect at 36 months was also seen on scores assessing emotional/informational social support, depression symptoms, and internalized stigma. An intervention using peer community support workers with HIV to provide individualized informational and psychological support had a positive impact on the emotional health of people living with HIV who were new to care.

(ClinicalTrials.gov protocol ID: 1410S54203, May 19, 2015).

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Acknowledgements

Ethiopian study coordinators were Anteneh Mengistu, Behailu Dagne, Engidaw Ayele, Hiwot Tekle, Simret Girma, Signe Tefera, Tesfaye Gemechu, Tsedey Ayele, Tewabe Tamiru, and Yayush Tesfaye. We thank: Lindsey Fabian, Madelyn Tillemans and Lauren Berg from the University of Minnesota; Lucy Slater from the National Alliance of State and Territorial AIDS Directors; and the Southern Nations, Nationalities, and Peoples’ Region Regional Health Bureau. Additional details on the study protocol are available from Dr. Lifson. We especially thank all people living with HIV for their generous participation in this study.

Funding

Funding was provided by the National Institute of Mental Health, NIH, Grant: 5R01MH105290.

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Authors and Affiliations

  1. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA

    Alan R. Lifson, Richard F. MacLehose, Keith J. Horvath & Rose Hilk

  2. Ethiopian Office, National Alliance of State and Territorial AIDS Directors, Addis Ababa, Ethiopia

    Abera Hailemichael, Sale Workneh & Tibebe Shenie

  3. Department of Psychology, San Diego State University, San Diego, CA, USA

    Keith J. Horvath

  4. Global Program, National Alliance of State and Territorial AIDS Directors, Washington, DC, USA

    Anne Sites

  5. Division of Epidemiology and Community Health, University of Minnesota, 1300 S. Second Street, Suite 300, Minneapolis, MN, 55454-1015, USA

    Alan R. Lifson

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Contributions

All authors were involved in design and implementation of the study, including development of data collection instruments, and provided intellectual feedback on interpretation of results included in this manuscript. ARL was lead investigator on all aspects of the project, and wrote the manuscript with assistance from co-authors. AH, SW, and TS had primary responsibility for local data collection and coordination with all local partners. AH, RH and RFM managed the study’s data set. RFM was project statistician and lead on data analysis. KJH provided methodical guidance on psychosocial measures and their interpretation. AS, AH and TS provided administrative support for financial and other logistical requirements.

Corresponding author

Correspondence to Alan R. Lifson.

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Competing Interests

The authors have no competing financial or non-financial interests to disclose.

Ethical Approval

Ethiopia’s Ministry of Science and Technology National Research Ethics Committee and the University of Minnesota Institutional Review Board approved this study.

Informed Consent

All participants provided signed informed consent after verbal explanation of consent provisions. De-identified dataset is not available as participants and the Ethiopian review agencies did not consent to the use of data by researchers outside the study team.

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Lifson, A.R., Hailemichael, A., Workneh, S. et al. Impact of Community Support Workers in Rural Ethiopia on Emotional and Psychosocial Health of Persons Living with HIV: Results of a Three-Year Randomized Community Trial. AIDS Behav 27, 2834–2843 (2023). https://doi.org/10.1007/s10461-023-04007-1

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