Wellcome Trust Clincal PhD Programme at the University of Liverpool: 'The IDEA study: intervention to address delays in equitable access to ART.' (360G-Wellcome-089673_B_09_Z)

The research aims of this project are to understand the barriers to uptake of antiretroviral therapy (ART) among eligible HIV-infected adults in Malawi; and to investigate the effect of a Lay Health Worker (LHW)-provided educational and support intervention in improving access to ART. This research will be undertaken in two phases. Firstly we will undertake a cohort study of newly diagnosed HIV-positive adults in the primary health care system in Blantyre. Mixed quantitative and qualitative methods will be used. Uptake of ART in eligible participants; uptake of CD4 count sampling; collection of CD4 results; collection of cotrimoxazole preventative therapy; hospital illness episodes; and mortality will be assessed for four months following HIV diagnosis, with home-based tracing where necessary. Semi-structured in-depth interviews will be undertaken with participants both successful and unsuccessful in initiating ART to investigate pathways and barriers to accessing care. Positive-living people with HIV in Blantyre will be recruited as Lay Health Workers. LHWs will undergo a two-month participatory training programme, building upon findings from the cohort study and LHW's own experiences of care-seeking, to develop an educational and community support intervention. LHWs will be trained in providing the study intervention and in data collection procedures and Good Clinical Practice. All LHWs will receive a salary and transport in the form of a bicycle. In the second phase, we will conduct a randomised controlled trial to test the hypothesis that newly diagnosed HIV-positive adults receiving an intensive educational and support intervention provided by LHWs will be more successful at accessing ART compared to standard care.