Peer Clinic-Community Health Workers, mHealth, and HIV Care and Prevention Studies at the Rakai Health Sciences Program in Uganda
The Rakai Health Sciences Program (RHSP) is a large and well established program focused on HIV-related research in southwestern Uganda (www.rhsp.org). We have several implementation science projects focused on improving HIV care and prevention. These include (i) improving HIV care and prevention service delivery in very high HIV prevalence fishing communities using a peer clinic-community health worker approach that also leverages mHealth; (ii) improving HIV care and prevention service delivery in a more typical semi-agrarian population using a peer clinic-community health worker approach that also leverages mHealth; (iii) ongoing analyses of the PeerCARE (Community Assistant in REtention) Study, a community-based, pragmatic, randomized, controlled trial of a peer intervention to improve engagement in prevention and care services among people living with HIV who are not yet on antiretroviral therapy; (iv) geospatial analyses of HIV service delivery and patient-oriented outcomes; and (v) novel uses of mHealth to collect behavioral data and deliver real-time interventions.
Global Health Mentor: Larry Williams Chang, MD
My GHEFP placement in rural Uganda was definitely a learning experience. Although the work experience and skills that I gained were important, I think that the most unique and beneficial things that I gained through the experience were non-work related. I lived in Kalisizo, Uganda (about 2 hours south of Kampala) for 3.5 months to help with a new research project focusing on using a mobile health application and Community Health Workers (CHWs) to reduce HIV-related outcomes in a rural fishing village called Kasensero. Kasensero is considered an HIV “hotspot”, with a HIV prevalence of approximately 44%, so is a very unique public health setting to work in. My primary responsibility was to develop a training program for the CHWs and conduct the initial training and refresher courses during the study launch. I gained a lot of experience on developing training materials and objectives, adapting training curricula to a local context, and conducting trainings for CHWs. While those skills are important and rewarding, I think I could’ve gained similar professional skills working on a CHW-related project in Baltimore or other more familiar areas around the United States. The “once in a lifetime” experiences I had primarily came from the context in which I applied this skills and my interactions with co-workers and other people in the village.
The research study I worked on is being conducted in partnership with the Rakai Health Sciences Program (RHSP), which is one of the oldest community-based research endeavors on HIV. I learned so much from the staff there about the status of health services in the area, the interaction between policy and care, and most notably, the country’s commitment to improving the health of its citizens. This commitment was very obviously embedded in the program’s staff. Most of the staff had families and homes in Kampala and traveled each week to live in Kalisizo from Monday-Friday and see patients, run projects, and conduct research. They spent this time away from their families and worked long hours in order to accomplish everything they needed to before returning home on Friday.
Seeing that kind of sacrifice firsthand changed a lot of my perspective on conducting research in an LMIC. I think a lot of times we go into projects with the idea that we are going into a community to help them and change things and forget that there are so many people that live within the community and make much larger, long-term sacrifices to improve those areas. I developed a new respect for in-country research teams and saw local staff have as much, if not more, of a role and contribution to programs as staff from research institutions like Hopkins. This isn’t necessarily a groundbreaking observation, but seeing it in practice is an invaluable experience that I recommend to anyone who hasn’t worked in the field and is interested in conducting either research or program implementation in developing countries.
Overall, I feel humbled and grateful for the opportunity to work on my GHEFP project. I’m humbled knowing that going abroad for a few months is a very small contribution to the improvement of public health in the world, in Uganda, and even in the village where I worked. However, I’m grateful to have had the opportunity to gain a better understanding of public health on a global scale and to better understand my own goals and priorities in order to move forward in my career and continue to make an impact, no matter how small, to the best of my abilities.
Conducting a drama show to introduce the study to the community:
Role-playing to demonstrate counseling concepts durign CHW training:
Walking randomized cluster boundaries with CHWs to show them their intervention areas:
Taking a break during CHW training:
Hiking in Sipi Falls in northern Uganda: