TB/HIV-related training, knowledge and attitudes of community health workers in the Free State province, South Africa.

With its emphasis on task shifting and multi-trained and skilled outreach teams the primary healthcare (PHC) re-engineering strategy in South Africa depends on the training, knowledge and attitudes of community health workers (CHWs) to provide a variety of TB/HIV services. The aim of this exploratory research was to assess TB/ HIV-related training, knowledge and attitudes of CHWs. Interviews were conducted with 206 CHWs at 28 clinics in 1 urban and 2 rural sub-districts in the Free State province. Descriptive and bivariate analyses were performed using chi-square, Kruskal-Wallis (H) and Mann-Whitney (U) tests for non-parametric data. More than half (54.9%) had not received basic training in HIV counselling and testing; almost one-third (31.1%) had not received basic training in TB/directly observed treatment (DOT) support. Furthermore, most CHWs had not received any follow-up training in HIV counselling and testing and in TB/DOT support. Significant associations (0.01 < p < 0.05) between the types of CHWs and their sub-district location, and their TB/HIV-related training, knowledge and attitudes were observed. In respect of the TB/HIV knowledge items assessed, a large majority (>95%) were knowledgeable, with only a few being ignorant about important facts related to TB/HIV. Lay counsellors were significantly more knowledgeable about TB/HIV than TB/DOT supporters and other CHWs were. Most CHWs disagreed with stigmatising statements about people with TB/HIV. The sub-district location of CHWs was significantly associated with their attitudes towards people with TB/HIV. CHWs in the two rural sub-districts were more likely to agree with stigmatising statements. In the context of PHC re-engineering, this exploratory research suggests that CHW TB/HIV training, knowledge and attitudes can and need to be improved if integrated TB/HIV services are to be successfully task-shifted to them in line with policy recommendations.