Despite the availability of effective drugs, HIV remains a major global threat
Four decades after HIV/AIDS was recognized and declared an epidemic, the virus continues to pose a devastating threat to global public health. HIV has claimed almost 33 million lives, but advances in treatment and prevention of transmission — including the use of antiretroviral treatment (ART) — have made the virus a manageable chronic health condition. Yet even in regions where effective HIV care and treatments are available, high rates of infection persist.
UNAIDS set the 95-95-95 fast-track targets to end the AIDS epidemic by 2030, defined as 95% of people living with HIV knowing their HIV status, 95% of people who know their status receiving treatment, and 95% of people on HIV treatment having a suppressed viral load. While these ambitious goals are feasible, they require improved outreach, medication adherence, and patient engagement. A recently published study shows the potential for mobile health tools in combination with motivational interviewing strategies as a novel intervention for health workers treating HIV patients in areas with endemic infection.
Community Health Worker strategies could be key to improving HIV treatment
Community health workers (CHWs) play an essential role in combating HIV, particularly in resource-limited settings. CHWs refer community members to HIV testing and treatment, provide psychosocial support, and create invaluable connections with their local communities. Enabling CHWs to more effectively engage patients who are being treated for HIV is paramount to achieving the 95-95-95 targets.
This study mobilized CHWs to deliver a motivational interviewing-informed and mobile phone application-supported counseling strategy called “Health Scouts” in the community of Rakai, Uganda. The study’s aim was high and sustained Combined HIV Interventions (CHI) coverage, including HIV testing, ART, and voluntary medical male circumcision. The intervention was based in a situated Information, Motivation, and Behavioral Skills framework (sIMB) designed to increase patient engagement in HIV treatment. Health Scouts were recruited from the community and visited clients in the intervention arm of the study once every 3 months for approximately 3 years.
An innovative combination of motivational interviewing, mobile health tools, and the sIMB framework
During visits, Health Scouts counseled clients with the use of prompts from a mobile application. The mobile app supported Health Scouts in their decision-making and counseling, with modules tailored to individual and community needs, and based on where a client could most benefit given their HIV status.
Residents of Rakai completed a mid-study and end-study survey. At the end of the study, HIV-positive patients in the intervention arm had significantly higher HIV care coverage and ART coverage than those in the control arm. All men in the intervention arm had higher male circumcision coverage, and HIV-positive participants in the intervention arm had higher HIV viral suppression: although neither of these results was significant. These results demonstrate the promise of a theory-based community health worker intervention that combines motivational interviewing with the power of digital health tools in achieving comprehensive care and coverage for HIV in settings where the virus is endemic.
