{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T22:28:41Z","timestamp":1787696921254,"version":"build-2784847793"},"reference-count":29,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T00:00:00Z","timestamp":1661385600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["P30AI094189"],"award-info":[{"award-number":["P30AI094189"]}],"id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH107275"],"award-info":[{"award-number":["R01MH107275"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J STD AIDS"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Effective models of support for HIV pre-exposure prophylaxis (PrEP) are needed for populations at elevated risk. In a hyperendemic Ugandan fishing community, PrEP counseling was provided through a situated Information, Motivation, and Behavioral Skills (sIMB)-based community health worker (CHW) intervention. We evaluated the intervention using a mixed-methods, implementation science design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We surveyed all community members aged 15-49 through the Rakai Community Cohort Study. We used multivariable logistic regressions with generalized estimating equations to estimate the intervention\u2019s effect on PrEP knowledge and utilization. To understand intervention experiences and mechanisms, we conducted 74 qualitative interviews with 5 informant types (clients, CHWs, program staff, community leaders, health clinic staff) and analyzed data using an iterative, deductive approach. A mobile phone application provided intervention process implementation data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Individuals self-reporting receipt of the CHW intervention showed significantly higher PrEP knowledge (N = 1848, PRR: 1.10, 95% CI: 1.06-1.14, p = &lt;.0001), PrEP ever use (N = 1176, PRR: 1.77, 95% CI: 1.33-2.36, p = &lt;.0001), and PrEP current use (N = 1176, PRR: 1.86, 95% CI: 1.22-2.82, p = 0.0039) compared to those who did not. Qualitative findings attributed positive PrEP outcomes to CHW counseling and effective use of motivational interviewing skills by CHWs. Salient themes across the RE-AIM framework included support for the CHW intervention and PrEP across clients, community, and implementers. Mobile application data demonstrated consistent delivery of the PrEP module throughout implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CHWs improved PrEP knowledge and use among clients in an HIV hyperendemic fishing community. Mixed-methods, implementation science evaluations can inform adaptation of similar PrEP implementation strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09564624221121208","type":"journal-article","created":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T13:14:44Z","timestamp":1661433284000},"page":"995-1004","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["Impact of community health worker intervention on PrEP knowledge and use in Rakai, Uganda: A mixed methods, implementation science evaluation"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1714-628X","authenticated-orcid":false,"given":"Abagail J","family":"Edwards","sequence":"first","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose","family":"Pollard","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin E","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"},{"name":"Rakai Health Sciences Program, Rakai, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremiah","family":"Mulamba","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Rakai, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"Mbabali","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Rakai, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aggrey","family":"Anok","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Rakai, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangrong","family":"Kong","sequence":"additional","affiliation":[{"name":"Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA"},{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"},{"name":"Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neema","family":"Nakyanjo","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Rakai, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Ddaaki","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Rakai, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Wawer","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA"},{"name":"Rakai Health Sciences Program, Rakai, Uganda"},{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K Rivet","family":"Amico","sequence":"additional","affiliation":[{"name":"Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi E","family":"Hutton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertrude","family":"Nakigozi","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Rakai, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry W","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"},{"name":"Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA"},{"name":"Rakai Health Sciences Program, Rakai, Uganda"},{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,8,25]]},"reference":[{"key":"bibr1-09564624221121208","volume-title":"Factsheet: Facts on HIV and AIDS in Uganda (Based on Data ending 31st December 2020)","author":"Uganda AIDS Commission, UNAIDS, Ministry of Health Uganda"},{"key":"bibr2-09564624221121208","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2015.1074715"},{"key":"bibr3-09564624221121208","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(16)30034-0"},{"key":"bibr4-09564624221121208","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-015-1077-z"},{"key":"bibr5-09564624221121208","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25588"},{"key":"bibr6-09564624221121208","volume-title":"Uganda \u2013 PrEPWatch","author":"AVAC"},{"key":"bibr7-09564624221121208","volume-title":"Consolidated Guidelines for Prevention and Treatment of HIV in Uganda","author":"Ministry of Health 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