Sarna, A., Luchters, S., Musenge, E., et al. Global Health: Science and Practice (March 2013), Vol. 1 No. 1, pp. 52-67.
In a controlled cohort study, the authors found that an HIV risk reduction intervention implemented by community health workers (CHW) for Kenyan people living with HIV (PLHIV) who knew their status, yet were not on HIV treatment, decreased reported risky sexual behaviors and increased antiretroviral therapy (ART) uptake. Of 325 participants in the intervention arm, 97 percent completed six months of follow-up, as did 94 percent of the 309 participants in the control arm. Among intervention participants, reported concurrent relationships in the past three months decreased from 42 percent at baseline to 18 percent at follow-up, and ART uptake increased significantly (from 0.3 percent to 35 percent) relative to the control group (0.3 percent to 12 percent). Intervention participants reported significantly less unprotected sex in the past month compared with the controls. Knowledge of HIV transmission and self-efficacy of condom use were higher among the intervention participants; however, they reported reduced concern about HIV transmission due to ART availability. More control participants had low internalized stigma scores at follow-up. The findings indicate that CHWs can deliver HIV interventions effectively in communities. The authors concluded that this intervention is suitable for scale-up and replication in similar resource-limited contexts to reach PLHIV who are not accessing HIV services.