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Seiler N, Horton K, Organick-Lee P, Heyison C, Osei A, Dwyer G, Karacuschansky A, Washington M, Spott A, Pearson WS. Use of Community Health Workers to Help End the Epidemic of Sexually Transmitted Infections. Public Health Rep 2024; 139:271-276. [PMID: 37846078 PMCID: PMC11037233 DOI: 10.1177/00333549231199481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Affiliation(s)
- Naomi Seiler
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Katie Horton
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Paige Organick-Lee
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Claire Heyison
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Alexis Osei
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Gregory Dwyer
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Aaron Karacuschansky
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Mekhi Washington
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Amanda Spott
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - William S. Pearson
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Humphries D, Marotta P, Hu Y, Wang V, Gross G, Rucker D, Jones J, Alam F, Brown T, Carter CR, Spiegelman D. St. Louis Enhancing Engagement and Retention in HIV/AIDS Care (STEER): a participatory intersectional needs assessment for intervention and implementation planning. RESEARCH SQUARE 2024:rs.3.rs-4225131. [PMID: 38746123 PMCID: PMC11092814 DOI: 10.21203/rs.3.rs-4225131/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Missouri is one of seven priority states identified by the Ending the HIV Epidemic Initiative, and St. Louis contains almost half of the people living with HIV (PLWH) in Missouri. As St. Louis has a marked history of structural racism and economic inequities, we utilized the Intersectionality Based Policy Analysis (IBPA) framework to guide a participatory needs assessment for planning and program development. Methods The planning team included researchers, the lead implementer from our community partner, and two community representatives, and had biweekly 60-90 minute meetings for 18 months. The planning team discussed and approved all research materials, reviewed and interpreted results, and made decisions about outreach, recruitment, conduct of the needs assessment and development of the planned intervention. The needs assessment integrated information from existing data, (1) interviews with (a) PLWH (n=12), (b) community leaders (n=5), (c) clinical leaders (n=4), and (d) community health workers (CHWs) (n=3) and (e) CHW supervisors (n=3) who participated in a Boston University-led demonstration project on CHWs in the context of HIV and (2) focus groups (2 FG, 12 participants) with front line health workers such as peer specialists, health coaches and outreach workers. A rapid qualitative analysis approach was used for all interviews and focus groups. Results The IBPA was used to guide team discussions of team values, definition and framing of the problem, questions and topics in the key informant interviews, and implementation strategies. Applying the IBPA framework contributed to a focus on intersectional drivers of inequities in HIV services. The effective management of HIV faces significant challenges from high provider turnover, insufficient integration of CHWs into care teams, and organizational limitations in tailoring treatment plans. Increasing use of CHWs for HIV treatment and prevention also faces challenges. People living with HIV (PLWH) encounter multiple barriers such as stigma, lack of social support, co-morbidities, medication side effects and difficulties in meeting basic needs. Conclusions Addressing intersectional drivers of health inequities may require multi-level, structural approaches. We see the IBPA as a valuable tool for participatory planning while integrating community engagement principles in program and implementation design for improving HIV outcomes.
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Affiliation(s)
| | - Phillip Marotta
- Washington University In St Louis: Washington University in St Louis
| | | | | | - Greg Gross
- Washington University In St Louis: Washington University in St Louis
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Morales-Torres L, Vélez-Maldonado DA, Rosario-Maldonado FJ, Aguirre-Hernández JM, Motta-Pagán JL, Rodríguez-Torruella D, Castro-Figueroa E, Ramos-Lucca A, Rivera-Mateo E, Marzán-Rodríguez M, Jiménez-Chávez J. Empowering Underserved Communities in Southern Puerto Rico: A Formal Training Program in Community Health Promotion. J Community Health 2024:10.1007/s10900-024-01346-5. [PMID: 38575835 DOI: 10.1007/s10900-024-01346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 04/06/2024]
Abstract
Community health promotion offers a potential solution to persistent healthcare challenges, with community health workers playing a pivotal role. The Community Training Institute for Health Disparities (CTIHD) implemented a problem-solving curriculum in Community Health Promotion, integrating a competency-based learning model through two courses: Introduction to Community Health Promotion and Design of an Action Plan for the Promotion of Community Health. Each course comprised ten three-hour sessions, featuring pre/post-tests, evaluations, and a cognitive debriefing. Knowledge change was assessed using pre/post-test scores among 27 community leaders from southern Puerto Rico. Cohort 1 and Cohort 2 demonstrated an overall retention rate of 62.6% and 96.7%, respectively. Although differences in knowledge gained between cohorts and courses weren't statistically significant, a trend toward increased knowledge was noted. Cohort 1 experienced a 22% knowledge increase in Course 1 and a 24% increase in Course 2. Cohort 2 demonstrated a 41% knowledge increase in Course 1 and a 25% increase in Course 2. The CTIHD's Community Health Promotion Program has made significant strides in elevating awareness and knowledge, marking a positive step toward reducing health disparities and fostering healthier, empowered communities in southern Puerto Rico.
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Affiliation(s)
- Luisa Morales-Torres
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico.
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico.
| | - David A Vélez-Maldonado
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Fernando J Rosario-Maldonado
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Jeannie M Aguirre-Hernández
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Jorge L Motta-Pagán
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | | | - Eida Castro-Figueroa
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Axel Ramos-Lucca
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Elizabeth Rivera-Mateo
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Melissa Marzán-Rodríguez
- Public Health Program, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
| | - Julio Jiménez-Chávez
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, P.O. Box 7004, Ponce, 00732-7004, Puerto Rico
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Harrison SE, Paton M, Muessig KE, Vecchio AC, Hanson LA, Hightow-Weidman LB. "Do I want PrEP or do I want a roof?": Social determinants of health and HIV prevention in the southern United States. AIDS Care 2022; 34:1435-1442. [PMID: 35109734 PMCID: PMC9343473 DOI: 10.1080/09540121.2022.2029816] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 01/10/2022] [Indexed: 12/31/2022]
Abstract
Scaling up use of Pre-Exposure Prophylaxis (PrEP) among young men who have sex with men and transgender women (YMSM/TGW) is a critical part of the Ending the HIV Epidemic plan. This qualitative study contextualized the social determinants of health (SDOH) that can impede HIV prevention in rural North and South Carolina with 14 key informant interviews with stakeholders and 3 focus groups with YMSM/TGW (N = 23). A deductive-inductive approach with multiple coders was employed to identify themes related to SDOH in rural areas, including economic challenges (e.g., housing and food insecurity), neighborhood characteristics (e.g., lack of transportation), healthcare-related issues (e.g., provider shortages) and educational barriers (e.g., lack of comprehensive and inclusive sexual education). The socio-environmental context of the rural South and prioritization of local, community-based partnerships are necessary to reduce the burden of HIV.
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Affiliation(s)
- Sayward E. Harrison
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, South Carolina
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina
| | - Mariajosé Paton
- Department of Psychology, University of South Carolina, Barnwell College, Columbia, South Carolina
| | - Kathryn E. Muessig
- Institute of Global Health and Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Alyssa C. Vecchio
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Lyd A. Hanson
- Institute of Global Health and Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, NC
| | - Lisa B. Hightow-Weidman
- Institute of Global Health and Infectious Diseases, University of North Carolina, School of Medicine, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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Ayala GX, Chan JCN, Cherrington AL, Elder J, Fisher EB, Heisler M, Howard AG, Ibarra L, Parada H, Safford M, Simmons D, Tang TS. Predictors and Effects of Participation in Peer Support: A Prospective Structural Equation Modeling Analysis. Ann Behav Med 2022; 56:909-919. [PMID: 35830356 DOI: 10.1093/abm/kaab114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Peer support provides varied health benefits, but how it achieves these benefits is not well understood. PURPOSE Examine a) predictors of participation in peer support interventions for diabetes management, and b) relationship between participation and glycemic control. METHODS Seven peer support interventions funded through Peers for Progress provided pre/post data on 1,746 participants' glycemic control (hemoglobin A1c), contacts with peer supporters as an indicator of participation, health literacy, availability/satisfaction with support for diabetes management from family and clinical team, quality of life (EQ-Index), diabetes distress, depression (PHQ-8), BMI, gender, age, education, and years with diabetes. RESULTS Structural equation modeling indicated a) lower levels of available support for diabetes management, higher depression scores, and older age predicted more contacts with peer supporters, and b) more contacts predicted lower levels of final HbA1c as did lower baseline levels of BMI and diabetes distress and fewer years living with diabetes. Parallel effects of contacts on HbA1c, although not statistically significant, were observed among those with baseline HbA1c values > 7.5% or > 9%. Additionally, no, low, moderate, and high contacts showed a significant linear, dose-response relationship with final HbA1c. Baseline and covariate-adjusted, final HbA1c was 8.18% versus 7.86% for those with no versus high contacts. CONCLUSIONS Peer support reached/benefitted those at greater disadvantage. Less social support for dealing with diabetes and higher PHQ-8 scores predicted greater participation in peer support. Participation in turn predicted lower HbA1c across levels of baseline HbA1c, and in a dose-response relationship across levels of participation.
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Affiliation(s)
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Andrea L Cherrington
- School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Elder
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Edwin B Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Michele Heisler
- Schools of Medicine and Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Annie Green Howard
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Leticia Ibarra
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Humberto Parada
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Monika Safford
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - David Simmons
- Campbelltown Hospital Endocrinology Department, Western Sydney University Macarthur Clinical School, Campbelltown, New South Wales, Australia
| | - Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Rajabiun S, Killion K, Lennon-Dearing R, Williams BB, Hirschi M. Using Implementation Science to Promote Integration and Sustainability of Community Health Workers in the HIV Workforce. J Acquir Immune Defic Syndr 2022; 90:S65-S73. [PMID: 35703757 DOI: 10.1097/qai.0000000000002966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community health worker (CHW) interventions are an evidence-based practice adopted by health care settings to increase retention in care and viral suppression for people living with HIV (PLWH) from racial/ethnic minority communities. However, disparate funding, unclear roles vis a vis other care team members, limited training and promotion opportunities, and a lack of standards for wages and tasks limit the ability to effectively use CHWs as part of the health care team. Guided by the Exploration, Preparation, Implementation, and Sustainment and Reach, Effectiveness, Adoption, Implementation, and Maintenance frameworks, this study describes the key determinants for CHW integration and sustainability at 3 agencies in Shelby County, TN, to improve viral suppression and reduce disparities among rural and urban people living with HIV. SETTING Memphis Transitional Grant Area (TGA) which includes 8 rural and urban counties in west Tennessee, Arkansas, and Mississippi. METHODS Seventeen key informants were identified using purposeful and snowball sampling techniques, including community and agency leadership staff, frontline staff, and faith leaders. RESULTS Key determinants of CHW integration include establishing clear and standardized CHW roles within and across organizations, facilitating interorganizational networks, and leveraging funds for livable CHW wages and sustainable positions. Training strategies that strengthen the CHW workforce include content related to trauma-informed care, managing stress, and cultural humility. CONCLUSION Several inner and outer settings and innovation and bridging factors affect CHW positions. Data collected will inform the implementation and sustainment of future policies and interventions intended to improve HIV care continuum outcomes and reduce disparities for PLWH.
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Affiliation(s)
- Serena Rajabiun
- Department of Public Health, University of Massachusetts, Lowell, MA; and
| | - Kate Killion
- Department of Public Health, University of Massachusetts, Lowell, MA; and
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McQuillin SD, Hagler MA, Werntz A, Rhodes JE. Paraprofessional Youth Mentoring: A Framework for Integrating Youth Mentoring with Helping Institutions and Professions. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 69:201-220. [PMID: 34318526 DOI: 10.1002/ajcp.12546] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The demand for child mental health services, including those provided by psychologists, counselors, and social workers, exceeds the supply. This trend is expected to continue or worsen unless there are substantial structural changes in how mental health services are provided. We propose a framework for paraprofessional youth mentors, defined as a subgroup of professionally supervised, non-expert volunteer or paid mentors to whom aspects of professional helping tasks are delegated. Our proposal is aligned with historical and modern solutions to scaling mental health services, and this framework could simultaneously increase the number of youth receiving evidence-based mental health services and reduce the burden on existing systems of care. The framework defines three plausible tasks for paraprofessional mentors: (1) reducing barriers to mental health service, (2) increasing engagement in services, and (3) providing direct services. The safety and effectiveness of these task-shifting efforts will hinge on competency-based training and evaluation, supervision by professionals, and documentation of services rendered, all of which the field of youth mentoring currently lacks. We describe several requisite scientific, institutional, and regulatory advances that will be necessary to realize this variant of youth mentoring for a subgroup of youth who are presenting for assistance with mental health problems.
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Affiliation(s)
- Samuel D McQuillin
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Matthew A Hagler
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Alexandra Werntz
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
| | - Jean E Rhodes
- Department of Psychology, University of Massachusetts Boston, Boston, MA, USA
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Rajabiun S, Lennon-Dearing R, Hirschi M, Davis B, Williams B, Sprague Martinez L, Campos M. Ending the HIV Epidemic: One Southern Community Speaks. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:647-664. [PMID: 34251984 PMCID: PMC8429130 DOI: 10.1080/19371918.2021.1947929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Memphis, Tennessee and its surrounding counties have been profoundly affected by the HIV epidemic. Using a participatory research approach this study identified from a community perspective: 1) the barriers and facilitators for providing support to achieve viral suppression to the most at-risk groups living with HIV in the Memphis Transitional Grant Area and 2) opportunities to strengthen the health care system through the use of community health workers (CHWs) to do outreach and engage with people living with HIV. Themes of barriers include intersectional stigma, HIV criminal laws, abstinence-only sex education, housing, transportation, and limited access to HIV case management and mental health services. Strategies to address these barriers included HIV education to youth in schools and community-wide campaigns, more testing sites, involving faith leaders, funding for housing options, innovative transportation services, rapid start of culturally appropriate HIV medical treatment, intensive case management services, and mental health counseling. Two opportunities to utilize CHWs to address the barriers identified in this geographic area are as policy advocates and as an integrated member of the HIV primary care team. The findings of this study can inform a strategy to build the CHW workforce which may have widespread implications for ending the HIV epidemic in this geographic area and across the United States.
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Affiliation(s)
- Serena Rajabiun
- Lowell Zuckerberg College of Health Sciences, University of Massachusetts
| | | | | | | | | | | | - Maria Campos
- School of Social Work, Boston University, Boston, Massachusetts, USA
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Davoust M, Drainoni ML, Baughman A, Campos Rojo M, Estes T, Rajabiun S, Ross-Davis K, McCann K, Sullivan M, Todd L, Wolfe HL, Sprague Martinez L. "He Gave Me Spirit and Hope": Client Experiences with the Implementation of Community Health Worker Programs in HIV Care. AIDS Patient Care STDS 2021; 35:318-326. [PMID: 34375140 DOI: 10.1089/apc.2021.0085] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Community health workers (CHWs) are members of the frontline health workforce who serve as intermediaries between health services and communities. In the United States, the role of CHWs has begun to expand as they have been shown to improve outcomes and reduce inequities in care for chronic conditions. This study used qualitative methods to explore the experiences of clients in CHW programs to inform their implementation in HIV care. Thirty clients from 6 Ryan White HIV/AIDS Program care settings across the United States participated in individual semistructured interviews to learn more about their experiences working with a CHW. Four key themes arose from the client perspective. First, CHWs embodied key qualities. Some of the qualities clients attributed to CHWs included being caring and supportive, along with capable of fostering personal connections. Second, CHWs met clients where they were. Clients described the CHW approach as more holistic compared with other care team members; they emphasized CHWs were able to focus on whatever was needed in that moment. Third, CHWs occupied a unique role in the HIV care team. Clients noted CHWs had more time to dedicate to their interactions; they also saw CHWs as representing a different level of authority. Finally, CHWs influenced how clients engaged with care and accessed resources. This included empowering clients to access resources independently in the future. Overall, clients' perceptions of CHWs in terms of their qualities, approach, role, and influence on the HIV care experience suggest they are a valuable resource on the care team.
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Affiliation(s)
- Melissa Davoust
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Allyson Baughman
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Maria Campos Rojo
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Terry Estes
- Southwest Louisiana AIDS Council, Lake Charles, Louisiana, USA
| | - Serena Rajabiun
- Department of Public Health, University of Massachusetts—Lowell, Lowell, Massachusetts, USA
| | - Kelly Ross-Davis
- 1917 Clinic at the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katherine McCann
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Marena Sullivan
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - LaWanda Todd
- Division of Infectious Diseases and International Travel Health, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Hill L. Wolfe
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Linda Sprague Martinez
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
- Macro Department, Boston University School of Social Work, Boston, Massachusetts, USA
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10
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Pettit AC, Bian A, Schember CO, Rebeiro PF, Keruly JC, Mayer KH, Mathews WC, Moore RD, Crane HM, Geng E, Napravnik S, Shepherd BE, Mugavero MJ. Development and Validation of a Multivariable Prediction Model for Missed HIV Health Care Provider Visits in a Large US Clinical Cohort. Open Forum Infect Dis 2021; 8:ofab130. [PMID: 34327249 PMCID: PMC8314944 DOI: 10.1093/ofid/ofab130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/12/2021] [Indexed: 11/12/2022] Open
Abstract
Background Identifying individuals at high risk of missing HIV care provider visits could support proactive intervention. Previous prediction models for missed visits have not incorporated data beyond the individual level. Methods We developed prediction models for missed visits among people with HIV (PWH) with ≥1 follow-up visit in the Center for AIDS Research Network of Integrated Clinical Systems from 2010 to 2016. Individual-level (medical record data and patient-reported outcomes), community-level (American Community Survey), HIV care site–level (standardized clinic leadership survey), and structural-level (HIV criminalization laws, Medicaid expansion, and state AIDS Drug Assistance Program budget) predictors were included. Models were developed using random forests with 10-fold cross-validation; candidate models with the highest area under the curve (AUC) were identified. Results Data from 382 432 visits among 20 807 PWH followed for a median of 3.8 years were included; the median age was 44 years, 81% were male, 37% were Black, 15% reported injection drug use, and 57% reported male-to-male sexual contact. The highest AUC was 0.76, and the strongest predictors were at the individual level (prior visit adherence, age, CD4+ count) and community level (proportion living in poverty, unemployed, and of Black race). A simplified model, including readily accessible variables available in a web-based calculator, had a slightly lower AUC of .700. Conclusions Prediction models validated using multilevel data had a similar AUC to previous models developed using only individual-level data. The strongest predictors were individual-level variables, particularly prior visit adherence, though community-level variables were also predictive. Absent additional data, PWH with previous missed visits should be prioritized by interventions to improve visit adherence.
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Affiliation(s)
- April C Pettit
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cassandra O Schember
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter F Rebeiro
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth H Mayer
- Fenway Health and Harvard Medical School, Boston, Massachusetts, USA
| | - W Christopher Mathews
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Richard D Moore
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Heidi M Crane
- Division of Infectious Diseases, University of Washington School of Medicine, Seattle, Washington, USA
| | - Elvin Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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Evaluation of a novel community-based COVID-19 'Test-to-Care' model for low-income populations. PLoS One 2020; 15:e0239400. [PMID: 33035216 PMCID: PMC7546468 DOI: 10.1371/journal.pone.0239400] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022] Open
Abstract
Background After a COVID-19 diagnosis, vulnerable populations face considerable logistical and financial challenges to isolate and quarantine. We developed and evaluated a novel, community-based approach (‘Test-to-Care’ Model) designed to address these barriers for socioeconomically vulnerable Latinx individuals with newly diagnosed COVID-19 and their households. Methods This three-week demonstration project was nested within an epidemiologic surveillance study in a primarily Latinx neighborhood in the Mission district of San Francisco, California. The Test-to-Care model was developed with input from community members and public health leaders. Key components included: (1) provision of COVID-19-related education and information about available community resources, (2) home deliveries of material goods to facilitate safe isolation and quarantine (groceries, personal protective equipment and cleaning supplies), and (3) longitudinal clinical and social support. Newly SARS-CoV-2 PCR-positive participants were eligible to participate. Components of the model were delivered by the Test-to-Care team, which was comprised of healthcare providers and community health workers (CHWs) who provided longitudinal clinic- and community-based support for the duration of the isolation period to augment existing services from the Department of Public Health (DPH). We evaluated the Test-to-Care Model using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework and drew upon multiple data sources including: programmatic data, informal interviews with participants and providers/CHWs and structured surveys among providers/CHWs. Results Overall, 83 participants in the surveillance study were diagnosed with COVID-19, of whom 95% (79/83) were Latinx and 88% (65/74) had an annual household income <$50,000. Ninety-six percent (80/83) of participants were reached for results disclosure, needs assessment and DPH linkage for contact tracing. Among those who underwent an initial needs assessment, 45% (36/80) were uninsured and 55% (44/80) were not connected to primary care. Sixty-seven percent (56/83) of participants requested community-based CHW support to safely isolate at their current address and 65% (54/83) of all COVID-19 participants received ongoing community support via CHWs for the entire self-isolation period. Participants reported that the intervention was highly acceptable and that their trust increased over time–this resulted in 9 individuals who disclosed a larger number of household members than first reported, and 6 persons who requested temporary relocation to a hotel room for isolation despite initially declining this service; no unintended harms were identified. The Test-to-Care Model was found to be both acceptable and feasible to providers and CHWs. Challenges identified included a low proportion of participants linked to primary care despite support (approximately 10% after one month), and insufficient access to financial support for wage replacement. Conclusions The Test-to-Care Model is a feasible and acceptable intervention for supporting self-isolation and quarantine among newly diagnosed COVID-19 patients and their households by directly addressing key barriers faced by socioeconomically vulnerable populations.
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Benbow ND, Aaby DA, Rosenberg ES, Brown CH. County-level factors affecting Latino HIV disparities in the United States. PLoS One 2020; 15:e0237269. [PMID: 32785252 PMCID: PMC7423131 DOI: 10.1371/journal.pone.0237269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/22/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To determine which county-level social, economic, demographic, epidemiologic and access to care factors are associated with Latino/non-Latino White disparities in prevalence of diagnosed HIV infection. METHODS AND FINDINGS We used 2016 county-level prevalence rates of diagnosed HIV infection rates for Latinos and non-Latino Whites obtained from the National HIV Surveillance System and factors obtained from multiple publicly available datasets. We used mixed effects Poisson modeling of observed HIV prevalence at the county-level to identify county-level factors that explained homogeneous effects across race/ethnicity and differential effects for Latinos and NL-Whites. Overall, the median Latinos disparity in HIV prevalence is 2.4; 94% of the counties have higher rates for Latinos than non-Latinos, and one-quarter of the counties' disparities exceeded 10. Of the 41 county-level factors examined, 24 showed significant effect modification when examined individually. In multi-variable modeling, 11 county-level factors were found that significantly affected disparities. Factors that increased disparity with higher, compared to lower values included proportion of HIV diagnoses due to injection drug use, percent Latino living in poverty, percent not English proficient, and percent Puerto Rican. Latino disparities increased with decreasing percent severe housing, drug overdose mortality rate, percent rural, female prevalence rate, social association rate, percent change in Latino population, and Latino to NL-White proportion of the population. These factors while significant had minimal effects on diminishing disparity, but did substantially reduce the variance in disparity rates. CONCLUSIONS Large differences in HIV prevalence rates persist across almost all counties even after controlling for county-level factors. Counties that are more rural, have fewer Latinos, or have lower NL-White prevalence rates tend to have higher disparities. There is also higher disparity when community risk is low.
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Affiliation(s)
- Nanette D. Benbow
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- * E-mail:
| | - David A. Aaby
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Eli S. Rosenberg
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York, United States of America
| | - C. Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Lorente N, Sherriff N, Panochenko O, Marcus U, Dutarte M, Kuske M, Aussó S, Huber J, Krone M, Schink SB, Cawley C, Casabona J, Folch C. The Role of Community Health Workers Within the Continuum of Services for HIV, Viral Hepatitis, and Other STIs Amongst Men Who Have Sex with Men in Europe. J Community Health 2020; 46:545-556. [PMID: 32737744 PMCID: PMC7393028 DOI: 10.1007/s10900-020-00900-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about Community Health Workers (CHWs) who work in non-clinical settings to provide sexual health support around HIV, viral hepatitis, and other sexually transmitted infections (STIs) to men who have sex with men (MSM) in Europe and neighbouring countries. This article describes for the first time, who CHWs are, and how they contribute to the continuum of services for HIV, viral hepatitis, and other STIs amongst MSM. The first European Community Health Worker Online Survey (ECHOES) developed in the framework of the EU-funded ESTICOM project (www.esticom.eu), was available in 16 languages (October 2017-January 2018). Amongst the 1035 persons aged 18 and older reporting CHW activities in the previous 12 months, 28.2% were women, 30.7% were volunteers, 59.2% were men self-defining as gay/homosexual, bisexual or queer (‘peer CHWs’), and most CHWs worked/volunteered in private not-for-profit organisations (86.4%). CHWs involvement in the continuum of services for HIV, viral hepatitis and other STIs was as follows: primary prevention (88.6%), consultation and counselling (58.0%), testing provision (50.6%), linkage to care (49.8%), and treatment and support activities (51.3%). CHWs were also involved in cross-cutting activities such as developing interventions, advocacy, and engaging in research (46.3%). CHWs as a public health workforce contribute to all steps of the continuum of services for HIV, viral hepatitis, and other STIs amongst MSM in Europe. National governments should recognise and support CHWs better in order to make their activities more visible and sustainable, and increase their impact on the continuum of services.
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Affiliation(s)
- Nicolas Lorente
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain.
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain.
- Centre D'Estudis Epidemiològics Sobre Les ITS I Sida de Catalunya (CEEISCAT), Fundació Institut D'Investigació en Ciències de La Salut Germans Trias I Pujol (IGTP), Edifici Muntanya, Carretera de Can Ruti, Camí de les Escoles s/n, 08916, Badalona, Barcelona, Spain.
| | - Nigel Sherriff
- School of Health Sciences, and Centre for Transforming Sexuality & Gender, University of Brighton, Brighton, BN1 9PH, UK
| | | | | | - Maria Dutarte
- European AIDS Treatment Group (EATG), 1000, Brussels, Belgium
- European Patients' Forum (EPF), 1040, Brussels, Belgium
| | | | - Susanna Aussó
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain
| | - Jörg Huber
- School of Health Sciences, and Centre for Transforming Sexuality & Gender, University of Brighton, Brighton, BN1 9PH, UK
| | | | | | | | - Jordi Casabona
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva, Universitat Autònoma de Barcelona, 08916, Badalona (Barcelona), Spain
| | - Cinta Folch
- Centre Estudis Epidemiològics Sobre Les Infeccions de Transmissió Sexual I Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya, 08916, Badalona (Barcelona), Spain
- Institut Investigació Germans Trias I Pujol (IGTP), 08916, Badalona (Barcelona), Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), 28029, Madrid, Spain
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Rooks-Peck CR, Wichser ME, Adegbite AH, DeLuca JB, Barham T, Ross LW, Higa DH, Sipe TA. Analysis of Systematic Reviews of Medication Adherence Interventions for Persons with HIV, 1996-2017. AIDS Patient Care STDS 2019; 33:528-537. [PMID: 31750731 PMCID: PMC8237207 DOI: 10.1089/apc.2019.0125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This overview of reviews summarizes the evidence from systematic reviews (SR) on the effectiveness of antiretroviral therapy (ART) adherence interventions for people with HIV (PWH) and descriptively compares adherence interventions among key populations. Relevant articles published during 1996-2017 were identified by comprehensive searches of CDC's HIV/acquired immunodeficiency syndrome (AIDS) Prevention Research Synthesis Database and manual searches. Included SRs examined primary interventions intended to improve ART adherence, focused on PWH, and assessed medication adherence or biologic outcomes (e.g., viral load). We synthesized the qualitative data and used the Assessment of Multiple Systematic Reviews (AMSTAR) for quality assessment. Forty-one SRs met inclusion criteria. Average quality was high. SRs that evaluated text-messaging interventions (n = 9) consistently reported statistically significant improvements in adherence and biologic outcomes. Other ART adherence strategies [e.g., behavioral, directly administered antiretroviral therapy (DAART)] reported improvements, but did not report significant effects for both outcomes, or intervention effects that did not persist postintervention. In the review focused on people who inject drugs (n = 1), DAART alone or in combination with medication-assisted therapy improved both outcomes. In SRs focused on children or adolescents aged <18 years (n = 5), regimen-related and hospital-based DAART improved biologic outcomes. ART adherence interventions (e.g., text-messaging) improved adherence and biologic outcomes; however, results differed for other intervention strategies, populations, and outcomes. Because few SRs reported evidence for populations at high risk (e.g., men who have sex with men), the results are not generalizable to all PWH. Future implementation studies are needed to examine medication adherence interventions in specific populations and address the identified gaps.
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Affiliation(s)
- Cherie R. Rooks-Peck
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Julia B. DeLuca
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Terrika Barham
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leslie W. Ross
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Darrel H. Higa
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theresa Ann Sipe
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Prevention Research Synthesis Project
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Young B, Rosenthal A, Escarfuller S, Shah S, Carrasquillo O, Kenya S. Beyond the Barefoot Doctors: Using Community Health Workers to Translate HIV Research to Service. AIDS Behav 2019; 23:2879-2888. [PMID: 31468297 PMCID: PMC10183152 DOI: 10.1007/s10461-019-02636-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Miami-Dade leads the nation in new HIV infections, and its Black communities experience the greatest disparities in outcomes. Our prior research found that street-based HIV testing facilitated by community health workers improved access to testing and care among Black adults in a controlled trial setting. Herein, we describe our efforts translating this CHW-led intervention into a community service for diverse Blacks in Miami. From December 2016 through August 2017, CHWs educated 1672 individuals about HIV transmission, prevention methods, and risk factor modification; 529 received HIV testing and/or linkage to care services. Approximately 5% of participants (n = 26) had rapid reactive results. This efficacious and culturally-acceptable model represents a powerful change in the delivery of HIV care and demonstrates how public health leaders can foster community engagement in the transition from research to service.
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Affiliation(s)
- BreAnne Young
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
- Don Soffer Clinical Research Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 960, Miami, FL, 33136, USA.
| | - Amanda Rosenthal
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sebastian Escarfuller
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Simran Shah
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Olveen Carrasquillo
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonjia Kenya
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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McQuillin SD, Lyons MD, Becker KD, Hart MJ, Cohen K. Strengthening and Expanding Child Services in Low Resource Communities: The Role of Task-Shifting and Just-in-Time Training. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 63:355-365. [PMID: 30834554 DOI: 10.1002/ajcp.12314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In the United States, the demand for child mental health services is increasing, while the supply is limited by workforce shortages. These shortages are unlikely to be corrected without significant structural changes in how mental health services are provided. One strategy for bridging this gap is task-shifting, defined as a process by which services that are typically delivered by professionals are moved to individuals with less extensive qualifications or training. Although task-shifting can increase the size of the workforce, there are challenges related to training new workers. In this paper, we propose Just-In-Time Training (JITT) as one strategy for improving task-shifting efforts. We define JITT as on-demand training experiences that only include what is necessary, when it is necessary, to promote competent service delivery. We offer a proof of concept from our own work shifting counseling and academic support tasks from school mental health professionals to pre-baccalaureate mentors, citing lessons learned during our iterative process of JITT development. We conclude with a series of key considerations for scaling up the pairing of task-shifting and JITT, including expanding the science of JITT and anticipating how task-shifting and JITT would work within the context of dynamic mental health service systems.
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Affiliation(s)
| | | | | | | | - Katie Cohen
- University of South Carolina, Columbia, SC, USA
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Sangeda RZ, Mosha F, Aboud S, Kamuhabwa A, Chalamilla G, Vercauteren J, Van Wijngaerden E, Lyamuya EF, Vandamme AM. Predictors of non adherence to antiretroviral therapy at an urban HIV care and treatment center in Tanzania. Drug Healthc Patient Saf 2018; 10:79-88. [PMID: 30174460 PMCID: PMC6109655 DOI: 10.2147/dhps.s143178] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Measurement of adherence to antiretroviral therapy (ART) can serve as a proxy for virologic failure in resource-limited settings. The aim of this study was to determine the factors underlying nonadherence measured by three methods. PATIENTS AND METHODS This is a prospective longitudinal cohort of 220 patients on ART at Amana Hospital in Dar es Salaam, Tanzania. We measured adherence using a structured questionnaire combining a visual analog scale (VAS) and Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ), pharmacy refill, and appointment keeping during four periods over 1 year. Overall adherence was calculated as the mean adherence for all time points over the 1 year of follow-up. At each time point, adherence was defined as achieving a validated cutoff for adherence previously defined for each method. RESULTS The proportion of overall adherence was 86.4% by VAS, 69% by SHCS-AQ, 79.8% by appointment keeping, and 51.8% by pharmacy refill. Forgetfulness was the major reported reason for patients to skip their medications. In multivariate analysis, significant predictors to good adherence were older age, less alcohol consumption, more advanced World Health Organization clinical staging, and having a lower body mass index with odds ratio (CI): 3.11 (1.55-6.93), 0.24 (0.09-0.62), 1.78 (1.14-2.84), and 0.93 (0.88-0.98), respectively. CONCLUSION We found relatively good adherence to ART in this setting. Barriers to adherence include young age and perception of well-being.
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Affiliation(s)
- Raphael Z Sangeda
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania,
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, KU Leuven - University of Leuven, Leuven, Belgium,
| | - Fausta Mosha
- Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Appolinary Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Jurgen Vercauteren
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, KU Leuven - University of Leuven, Leuven, Belgium,
| | - Eric Van Wijngaerden
- Department of General Internal Medicine, University Hospitals, KU Leuven - University of Leuven, Belgium
| | - Eligius F Lyamuya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anne-Mieke Vandamme
- Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, KU Leuven - University of Leuven, Leuven, Belgium,
- Center for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
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Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti. World J Surg 2018; 41:3025-3030. [PMID: 28948326 DOI: 10.1007/s00268-017-4246-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION In the Hôpital Albert Schweitzer district in rural Haiti, patients from mountain areas receive fewer operations per capita than patients from the plains. Possible additional barriers for mountain patients include lower socioeconomic status, lack of awareness of financial support, illiteracy and unfamiliarity with the hospital system. We sought to increase the rate of elective surgery for a mountain population using a patient navigation program. MATERIALS AND METHODS Patient navigators were trained to guide subjects from a mountain population through the entire hospital process for elective surgery. We compared the rate of elective operations before and after the patient navigation intervention between three groups: a control group from a mountainous area, a control group from the plains and an intervention group from a mountainous area. RESULTS The baseline elective operation rate differed significantly between the plains control group, the mountain control group and the mountain intervention group (361 vs. 57 vs. 68 operations per 100,000 population per year). The rate of elective surgery between the two mountain groups was not statistically different prior to the intervention. After the intervention, the elective operation rate in the mountain group that received patient navigation increased from 68 to 131 operations per 100,000 population per year (p = 0.017). DISCUSSION Patient navigation doubled the elective operation rate for a mountain population in rural Haiti. While additional barriers to access remain for this vulnerable population, patient navigation is an essential augmentation to financial assistance programs to ensure that the poor gain access to surgical care.
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Han HR, Kim K, Murphy J, Cudjoe J, Wilson P, Sharps P, Farley JE. Community health worker interventions to promote psychosocial outcomes among people living with HIV-A systematic review. PLoS One 2018; 13:e0194928. [PMID: 29689054 PMCID: PMC5915269 DOI: 10.1371/journal.pone.0194928] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 03/13/2018] [Indexed: 12/03/2022] Open
Abstract
Background Community health worker (CHW) interventions are a successful strategy to promote health among HIV-negative and persons living with HIV (PLWH). Psychosocial factors are critical dimensions of HIV/AIDS care contributing to prognosis of the disease, yet it is unclear how CHW interventions improve psychosocial outcomes in PLWH. The purpose of this study was to critically appraise the types, scope, and nature of CHW interventions designed to address psychosocial outcomes in PLWH. Methods We performed database searches—PubMed, EMBASE, CINAHL, and Cochrane—to identify randomized controlled trials published in English before April 2017. Fourteen articles met the eligibility criteria. Results Half of the studies were conducted in the United States. Social cognitive theory was used more than once in nine theory-guided studies. CHW interventions were largely focused on reducing depression (n = 6) or stigma related to HIV (n = 4), or promoting quality of life (n = 4), social support (n = 4), and self-efficacy (n = 4). Didactic methods and role-playing were used to train CHWs. CHWs played multiple roles in delivering intervention, including a counselor and a supporter (n = 10), educator (n = 5), or a navigator (n = 3). CHW intervention fidelity was assessed in 4 studies. Five studies found positive changes in six psychosocial outcomes including quality of life (2 of 4) and self-efficacy (2 of 4). CHW interventions had no effect on social support in 2 of 4 studies, and stigma in 3 of 4 studies. None of the CHW interventions were successful in reducing depressive symptoms among PLWH. Conclusions Evidence partially supported the use of CHWs in promoting psychosocial outcomes in PLWH. Future CHW intervention should be expanded in scope to address key psychosocial determinants of HIV/AIDS outcomes such as health literacy. Further, fidelity measures should be incorporated into intervention delivery.
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Affiliation(s)
- Hae-Ra Han
- The Johns Hopkins University, School of Nursing, Baltimore, Maryland, United States of America
- Center for Cardiovascular and Chronic Care, The Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Kyounghae Kim
- University of Connecticut, School of Nursing, Storrs, Connecticut, United States of America
| | - Jeanne Murphy
- The George Washington University School of Nursing, Ashburn, Virginia, United States of America
| | - Joycelyn Cudjoe
- The Johns Hopkins University, School of Nursing, Baltimore, Maryland, United States of America
| | - Patty Wilson
- The Johns Hopkins University, School of Nursing, Baltimore, Maryland, United States of America
| | - Phyllis Sharps
- The Johns Hopkins University, School of Nursing, Baltimore, Maryland, United States of America
| | - Jason E. Farley
- The Johns Hopkins University, School of Nursing, Baltimore, Maryland, United States of America
- The REACH Initiative, The Johns Hopkins University, Baltimore, Maryland, United States of America
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Thomas B, Priscilla Rebecca B, Dhanalakshmi A, Rani S, Deepa Lakshmi A, Watson B, Vijayalakshmi R, Muniyandi M, Karikalan N. Effectiveness of TB sensitization initiatives in improving the involvement of self help group members in rural TB control in south India. Trans R Soc Trop Med Hyg 2018; 110:714-720. [PMID: 28938052 DOI: 10.1093/trstmh/trx006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background The 'End TB strategy' has highlighted the importance of inter-sectoral collaboration and community mobilization for achieving zero TB deaths by 2020. Objective The aim of the study was to develop and test a model TB sensitization programme involving self help groups (SHGs). Methodology This experimental study was conducted in two blocks (intervention and control), in Tiruvallur district. The intervention content included short-lecture, musical story telling activity, role play, short film on TB. The impact was compared at baseline, third and sixth months in terms of SHGs' awareness, promotion of awareness, identification and referral of presumptive TB cases and provision of TB treatment. Results A total of 764 vs 796 SHGs were enrolled in control and intervention groups, respectively. The knowledge attitude, and practice score (lower score indicated a better attitude and practice), from baseline to 6 months was significantly reduced (29 to 24) in the intervention group. Similarly, a significant difference was observed in identification and referral of chest symptomatics in the intervention group at 3 and 6 months. During the 3 month follow-up a significantly higher proportion of SHG members were involved in TB awareness activities in the intervention (623/748 [83.3%]) vs control group (471/728 [64.7%]; p<0.001). Conclusions Findings from this study highlight the feasibility of involving SHGs through a model TB sensitization program for strengthening TB prevention and control activities.
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Affiliation(s)
- Beena Thomas
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - B Priscilla Rebecca
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - A Dhanalakshmi
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - S Rani
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - A Deepa Lakshmi
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - Basilea Watson
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - R Vijayalakshmi
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - M Muniyandi
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
| | - N Karikalan
- National Institute for Research in Tuberculosis (formerly Tuberculosis Research Centre), ICMR, Chennai, Tamil Nadu, India
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Teti M, Hayes D, Farnan R, Shaffer V, Gerkovich M. "Poems in the Entrance Area": Using Photo-Stories to Promote HIV Medication Adherence. Health Promot Pract 2017; 19:601-612. [PMID: 28891334 DOI: 10.1177/1524839917728049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adherence to antiretroviral medication among people living with HIV (PL-HIV) is critical to individual and public health. By some estimates only a quarter of PL-HIV are sufficiently adherent, underscoring a continued need for adherence-promoting strategies. In this analysis we explore the effect of adherence education posters developed via Photovoice. A group of PL-HIV generated images and captions to describe their adherence experiences and used their photo-stories to design 10 posters. We assessed viewers' ( N = 111) adherence knowledge, self-efficacy, and communication changes quantitatively and qualitatively before and 3 months after poster placement in the clinic. We analyzed quantitative data with an independent groups t test or a Mann-Whitney test, and qualitative interviews via theme analysis. Quantitative findings indicated no significant differences. Qualitative interviewees said that posters enhanced knowledge with nonthreatening, relatable information; self-efficacy by motivating patients to take medicine and disclose HIV to others; and communication by facilitating adherence conversations and creating a visually supportive clinic. Divergent quantitative and qualitative findings can be partially explained by inquiry methods. The posters may be more effective as part of discussions about their content, like those facilitated by qualitative interviews. Additional research regarding the application of Photovoice to health promotion is warranted.
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Affiliation(s)
| | - Deana Hayes
- 2 Truman Medical Centers in Kansas City, Kansas City, MO, USA
| | - Rose Farnan
- 2 Truman Medical Centers in Kansas City, Kansas City, MO, USA
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Fisher EB, Boothroyd RI, Elstad EA, Hays L, Henes A, Maslow GR, Velicer C. Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews. Clin Diabetes Endocrinol 2017; 3:4. [PMID: 28702258 PMCID: PMC5471959 DOI: 10.1186/s40842-017-0042-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/09/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Examine Peer Support (PS) for complex, sustained health behaviors in prevention or disease management with emphasis on diabetes prevention and management. DATA SOURCES AND ELIGIBILITY PS was defined as emotional, motivational and practical assistance provided by nonprofessionals for complex health behaviors. Initial review examined 65 studies drawn from 1442 abstracts identified through PubMed, published 1/1/2000-7/15/2011. From this search, 24 reviews were also identified. Extension of the search in diabetes identified 30 studies published 1/1/2000-12/31/2015. RESULTS In initial review, 54 of all 65 studies (83.1%) reported significant impacts of PS, 40 (61.5%) reporting between-group differences and another 14 (21.5%) reporting significant within-group changes. Across 19 of 24 reviews providing quantifiable findings, a median of 64.5% of studies reviewed reported significant effects of PS. In extended review of diabetes, 26 of all 30 studies (86.7%) reported significant impacts of PS, 17 (56.7%) reporting between-group differences and another nine (30.0%) reporting significant within-group changes. Among 19 of these 30 reporting HbA1c data, average reduction was 0.76 points. Studies that did not find effects of PS included other sources of support, implementation or methodological problems, lack of acceptance of interventions, poor fit to recipient needs, and possible harm of unmoderated PS. CONCLUSIONS Across diverse settings, including under-resourced countries and health care systems, PS is effective in improving complex health behaviors in disease prevention and management including in diabetes.
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Affiliation(s)
- Edwin B. Fisher
- Peers for Progress, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Box 7440, Chapel Hill, NC 27599-7440 USA
| | - Renée I. Boothroyd
- Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC USA
| | | | - Laura Hays
- Indiana University School of Nursing, Indianapolis, IN USA
| | - Amy Henes
- RTI International, Research Triangle Park, NC USA
| | - Gary R. Maslow
- Department of Pediatrics, Duke University, Durham, NC USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC USA
| | - Clayton Velicer
- National Public Relations and Communications, Kaiser Permanente, Oakland, CA USA
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Robillard A, Padi A, Lewis K, Julious C, Troutman J. Advice for prevention from HIV-positive African-American women: 'My story is not just a story'. CULTURE, HEALTH & SEXUALITY 2017; 19:630-642. [PMID: 27796161 DOI: 10.1080/13691058.2016.1243732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Large disparities in HIV incidence, prevalence and mortality exist for African-American women, especially in the southern region of the USA. Based on the culture-centric health promotion model, HIV-positive African American women can use their stories to support primary prevention. The purpose of this study was to document advice from HIV-positive African-American women (n = 25) to young African-American women, as described in their own cultural narratives collected through qualitative interviews. Content analysis of women's advice identified five common themes revolving broadly around: (1) advice for prevention, (2) support systems for prevention, (3) education, (4) empowerment/self-care and (5) potential barriers to prevention. Advice reflected recommendations based on personal experience and highlighted social determinants linked to HIV, such as stigma, access to education and healthcare, social support, and gender and power dynamics. Women also offered advice for coping with an HIV-positive diagnosis. Communication with parents, family and friends regarding education and social support emerged as an important interpersonal factor for participants, as were interactions with sexual/romantic partners. Stigma, at the community level, was consistently discussed as a hindrance to prevention. Narratives of HIV-positive women as community health agents of change can enhance the effectiveness of HIV prevention interventions for young US African-American women.
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Affiliation(s)
- Alyssa Robillard
- a Health Promotion, Education, and Behavior , University of South Carolina, Arnold School of Public Health , Columbia , USA
| | - Akhila Padi
- a Health Promotion, Education, and Behavior , University of South Carolina, Arnold School of Public Health , Columbia , USA
| | - Kaleea Lewis
- a Health Promotion, Education, and Behavior , University of South Carolina, Arnold School of Public Health , Columbia , USA
| | - Carmen Julious
- b Palmetto AIDS Life Support Services Inc , Columbia , USA
| | - Jamie Troutman
- a Health Promotion, Education, and Behavior , University of South Carolina, Arnold School of Public Health , Columbia , USA
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Jack HE, Arabadjis SD, Sun L, Sullivan EE, Phillips RS. Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review. J Gen Intern Med 2017; 32:325-344. [PMID: 27921257 PMCID: PMC5331010 DOI: 10.1007/s11606-016-3922-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 08/17/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND As the US transitions to value-based healthcare, physicians and payers are incentivized to change healthcare delivery to improve quality of care while controlling costs. By assisting with the management of common chronic conditions, community health workers (CHWs) may improve healthcare quality, but physicians and payers who are making choices about care delivery also need to understand their effects on healthcare spending. METHODS We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, and Web of Science from the inception of each database to 22 June 2015. We included US-based studies that evaluated a CHW intervention for patients with at least one chronic health condition and reported cost or healthcare utilization outcomes. We evaluated studies using tools specific to study design. RESULTS Our search yielded 2,941 studies after removing duplicates. Thirty-four met inclusion and methodological criteria. Sixteen studies (47%) were randomized controlled trials (RCTs). RCTs typically had less positive outcomes than other study designs. Of the 16 RCTs, 12 reported utilization outcomes, of which 5 showed a significant reduction in one or more of ED visits, hospitalizations and/or urgent care visits. Significant reductions reported in ED visits ranged from 23%-51% and in hospitalizations ranged from 21%-50%, and the one significant reduction in urgent care visits was recorded at 60% (p < 0.05 for all). DISCUSSION Our results suggest that CHW interventions have variable effects, but some may reduce costs and preventable utilization. These findings suggest that it is possible to achieve reductions in care utilization and cost savings by integrating CHWs into chronic care management. However, variations in cost and utilization outcomes suggest that CHWs alone do not make an intervention successful. The paucity of rigorous studies and heterogeneity of study designs limited conclusions about factors associated with reduced utilization.
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Affiliation(s)
- Helen E Jack
- Center for Primary Care, Harvard Medical School, Boston, MA, USA.
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
| | | | - Lucy Sun
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Erin E Sullivan
- Center for Primary Care, Harvard Medical School, Boston, MA, USA
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Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care. Med Care 2017; 55:140-147. [DOI: 10.1097/mlr.0000000000000618] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Powell RE, Doty A, Casten RJ, Rovner BW, Rising KL. A qualitative analysis of interprofessional healthcare team members' perceptions of patient barriers to healthcare engagement. BMC Health Serv Res 2016; 16:493. [PMID: 27644704 PMCID: PMC5028928 DOI: 10.1186/s12913-016-1751-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/14/2016] [Indexed: 12/26/2022] Open
Abstract
Background Healthcare systems increasingly engage interprofessional healthcare team members such as case managers, social workers, and community health workers to work directly with patients and improve population health. This study elicited perspectives of interprofessional healthcare team members regarding patient barriers to health and suggestions to address these barriers. Methods This is a qualitative study employing focus groups and semi-structured interviews with 39 interprofessional healthcare team members in Philadelphia to elicit perceptions of patients’ needs and experiences with the health system, and suggestions for positioning health care systems to better serve patients. Themes were identified using a content analysis approach. Results Three focus groups and 21 interviews were conducted with 26 hospital-based and 13 ambulatory-based participants. Three domains emerged to characterize barriers to care: social determinants, health system factors, and patient trust in the health system. Social determinants included insurance and financial shortcomings, mental health and substance abuse issues, housing and transportation-related limitations, and unpredictability associated with living in poverty. Suggestions for addressing these barriers included increased financial assistance from the health system, and building a workforce to address these determinants directly. Health care system factors included poor care coordination, inadequate communication of hospital discharge instructions, and difficulty navigating complex systems. Suggestions for addressing these barriers included enhanced communication between care sites, patient-centered scheduling, and improved patient education especially in discharge planning. Finally, factors related to patient trust of the health system emerged. Participants reported that patients are often intimidated by the health system, mistrusting of physicians, and fearful of receiving a serious diagnosis or prognosis. A suggestion for mitigating these issues was increased visibility of the health system within communities to foster trust and help providers gain a better understanding of unique community needs. Conclusion This work explored interprofessional healthcare team members’ perceptions of patient barriers to healthcare engagement. Participants identified barriers related to social determinants of health, complex system organization, and patient mistrust of the health system. Participants offered concrete suggestions to address these barriers, with suggestions supporting current healthcare reform efforts that aim at addressing social determinants and improving health system coordination and adding new insight into how systems might work to improve patient and community trust. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1751-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rhea E Powell
- Department of Medicine, Thomas Jefferson University, 833 Chestnut St, Suite 701, Philadelphia, PA, 19107, USA.
| | - Amanda Doty
- College of Public Health, Temple University, Philadelphia, PA, USA.,Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut Street, 300 Curtis Building, Philadelphia, PA, 19107, USA
| | - Robin J Casten
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, 900 Walnut Street, 2nd floor, Philadelphia, PA, 19107, USA
| | - Barry W Rovner
- Departments of Neurology and of Psychiatry and Human Behavior, Thomas Jefferson University, 900 Walnut Street, Suite 200, Philadelphia, PA, 19107, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut Street, 300 Curtis Building, Philadelphia, PA, 19107, USA
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Kim K, Choi JS, Choi E, Nieman CL, Joo JH, Lin FR, Gitlin LN, Han HR. Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review. Am J Public Health 2016; 106:e3-e28. [PMID: 26890177 PMCID: PMC4785041 DOI: 10.2105/ajph.2015.302987] [Citation(s) in RCA: 272] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Community-based health workers (CBHWs) are frontline public health workers who are trusted members of the community they serve. Recently, considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable populations who often face health inequities. OBJECTIVES We performed a systematic review to synthesize evidence concerning the types of CBHW interventions, the qualification and characteristics of CBHWs, and patient outcomes and cost-effectiveness of such interventions in vulnerable populations with chronic, noncommunicable conditions. SEARCH METHODS We undertook 4 electronic database searches-PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane-and hand searched reference collections to identify randomized controlled trials published in English before August 2014. SELECTION We screened a total of 934 unique citations initially for titles and abstracts. Two reviewers then independently evaluated 166 full-text articles that were passed onto review processes. Sixty-one studies and 6 companion articles (e.g., cost-effectiveness analysis) met eligibility criteria for inclusion. DATA COLLECTION AND ANALYSIS Four trained research assistants extracted data by using a standardized data extraction form developed by the authors. Subsequently, an independent research assistant reviewed extracted data to check accuracy. Discrepancies were resolved through discussions among the study team members. Each study was evaluated for its quality by 2 research assistants who extracted relevant study information. Interrater agreement rates ranged from 61% to 91% (average 86%). Any discrepancies in terms of quality rating were resolved through team discussions. MAIN RESULTS All but 4 studies were conducted in the United States. The 2 most common areas for CBHW interventions were cancer prevention (n = 30) and cardiovascular disease risk reduction (n = 26). The roles assumed by CBHWs included health education (n = 48), counseling (n = 36), navigation assistance (n = 21), case management (n = 4), social services (n = 7), and social support (n = 18). Fifty-three studies provided information regarding CBHW training, yet CBHW competency evaluation (n = 9) and supervision procedures (n = 24) were largely underreported. The length and duration of CBHW training ranged from 4 hours to 240 hours with an average of 41.3 hours (median: 16.5 hours) in 24 studies that reported length of training. Eight studies reported the frequency of supervision, which ranged from weekly to monthly. There was a trend toward improvements in cancer prevention (n = 21) and cardiovascular risk reduction (n = 16). Eight articles documented cost analyses and found that integrating CBHWs into the health care delivery system was associated with cost-effective and sustainable care. CONCLUSIONS Interventions by CBHWs appear to be effective when compared with alternatives and also cost-effective for certain health conditions, particularly when partnering with low-income, underserved, and racial and ethnic minority communities. Future research is warranted to fully incorporate CBHWs into the health care system to promote noncommunicable health outcomes among vulnerable populations.
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Affiliation(s)
- Kyounghae Kim
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Janet S Choi
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Eunsuk Choi
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Carrie L Nieman
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Jin Hui Joo
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Frank R Lin
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Laura N Gitlin
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
| | - Hae-Ra Han
- Kyounghae Kim and Hae-Ra Han are with The Johns Hopkins University School of Nursing, Baltimore, MD. Janet S. Choi, Carrie L. Nieman, and Frank R. Lin are with Center on Aging and Health, The Johns Hopkins University. Eunsuk Choi is with College of Nursing and Research Institute of Nursing Science, Kyungpook National University, Daegu, South Korea. Carrie L. Nieman and Jin Hui Joo are with Johns Hopkins University School of Medicine. Laura N. Gitlin is with Center for Innovative Care in Aging, Johns Hopkins University School of Nursing and Medicine. Hae-Ra Han is also with Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing
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Costa EF, Guerra PH, Santos TID, Florindo AA. Systematic review of physical activity promotion by community health workers. Prev Med 2015; 81:114-21. [PMID: 26297816 DOI: 10.1016/j.ypmed.2015.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the physical activity promotion in interventions conducted by community health workers. METHODS Systematic searches in five electronic databases (LILACS, PubMed, Scopus, Web of Science and SportDiscus) and manual searches in reference lists were conducted for papers published up until May 2014. The inclusion criteria were interventions delivered in adults by community health workers that had physical activity promotion as an objective (primary or secondary). RESULTS Of the 950 references initially retrieved, 26 were included in the descriptive synthesis. At the operational level, action strategies were predominantly based on the model of health education grounded in counseling, and delivered in populations at risk or diagnosed with chronic non-communicable diseases. Only five studies had the primary outcome of physical activity promotion and twenty-five studies used self-report methods for evaluation. The majority of studies (72.4%) were classified as having low or moderate risk of bias. Sixteen studies (61.5%) reported positive results for different parameters of physical activity. Most studies were carried out in the United States. The successful interventions were conducted over a period averaging 6.5 months and targeted mainly women, individuals older than thirty, specific ethnic groups, and syndromic or at-risk individuals. CONCLUSIONS The community health workers were important for physical activity promotion, but further interventions should be carried out in different countries and less specific samples, that include physical activity as a primary outcome and employ direct methods for assessing physical activity.
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Affiliation(s)
- Evelyn Fabiana Costa
- Post Graduation Program in Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil; Group of Studies and Researches in Physical Activity Epidemiology, University of São Paulo, São Paulo, SP, Brazil.
| | - Paulo Henrique Guerra
- Group of Studies and Researches in Physical Activity Epidemiology, University of São Paulo, São Paulo, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
| | - Taynã Ishii Dos Santos
- Group of Studies and Researches in Physical Activity Epidemiology, University of São Paulo, São Paulo, SP, Brazil
| | - Alex Antonio Florindo
- Post Graduation Program in Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil; Group of Studies and Researches in Physical Activity Epidemiology, University of São Paulo, São Paulo, SP, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, SP, Brazil
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IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents. J Int Assoc Provid AIDS Care 2015; 14 Suppl 1:S3-S34. [PMID: 26527218 DOI: 10.1177/2325957415613442] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An estimated 50% of people living with HIV (PLHIV) globally are unaware of their status. Among those who know their HIV status, many do not receive antiretroviral therapy (ART) in a timely manner, fail to remain engaged in care, or do not achieve sustained viral suppression. Barriers across the HIV care continuum prevent PLHIV from achieving the therapeutic and preventive effects of ART. METHODS A systematic literature search was conducted, and 6132 articles, including randomized controlled trials, observational studies with or without comparators, cross-sectional studies, and descriptive documents, met the inclusion criteria. Of these, 1047 articles were used to generate 36 recommendations to optimize the HIV care continuum for adults and adolescents. RECOMMENDATIONS Recommendations are provided for interventions to optimize the HIV care environment; increase HIV testing and linkage to care, treatment coverage, retention in care, and viral suppression; and monitor the HIV care continuum.
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Mannheimer S, Hirsch-Moverman Y. What we know and what we do not know about factors associated with and interventions to promote antiretroviral adherence. Curr Infect Dis Rep 2015; 17:466. [PMID: 25860778 DOI: 10.1007/s11908-015-0466-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Antiretroviral therapy (ART) adherence remains critical for achieving successful outcomes. Factors affecting ART adherence can occur at the individual level or be related to the treatment regimen, daily schedule, and/or interpersonal relationships. While treatment-related barriers have diminished with recent simplified ART regimens, guidelines still recommend considering regimen simplicity. ART readiness should be assessed prior to starting ART, with follow-up adherence assessments once ART is initiated, and at all subsequent clinical visits. Adherence interventions work best when multifaceted, targeted for at-risk and nonadherent participants, and tailored to individuals' needs. Successful interventions have included education and counseling, provision of social support, directly observed therapy, and financial incentives. Pillboxes and two-way short-text messaging service (SMS) reminders have been shown to be effective and are widely recommended tools for promoting ART adherence. Further research is needed to determine the optimal combination of adherence interventions, as well as generalizability, implementation, and cost-effectiveness.
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Affiliation(s)
- Sharon Mannheimer
- Division of Infectious Diseases, Department of Medicine, Harlem Hospital Center, New York, NY, USA,
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Beer L, Skarbinski J. Adherence to antiretroviral therapy among HIV-infected adults in the United States. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2014; 26:521-37. [PMID: 25490733 PMCID: PMC4579321 DOI: 10.1521/aeap.2014.26.6.521] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
National estimates of antiretroviral therapy (ART) adherence and adherence support services utilization are needed to inform efforts to improve the health of HIV-infected persons in the United States. In a nationally representative sample of HIV-infected adults receiving medical care, 86% self-reported taking all ART doses in the past 72 hours. Overall, 20% reported using adherence support services and 2% reported an unmet need for services. If all nonadherent persons not receiving adherence support and all persons with a self-perceived unmet need for adherence support accessed services, resources to support ∼42,673 additional persons would be needed. Factors associated with lower adherence included younger age, female gender, depression, stimulant use, binge alcohol use, greater than once-daily dosing, longer time since HIV diagnosis, and patient beliefs. Predictors of adherence are multifactorial so multiple targeted strategies to improve adherence are warranted. Providing adherence support services to all those in need may require additional resources.
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Hodgson I, Plummer ML, Konopka SN, Colvin CJ, Jonas E, Albertini J, Amzel A, Fogg KP. A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women. PLoS One 2014; 9:e111421. [PMID: 25372479 PMCID: PMC4221025 DOI: 10.1371/journal.pone.0111421] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 09/15/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Despite progress reducing maternal mortality, HIV-related maternal deaths remain high, accounting, for example, for up to 24 percent of all pregnancy-related deaths in sub-Saharan Africa. Antiretroviral therapy (ART) is effective in improving outcomes among HIV-infected pregnant and postpartum women, yet rates of initiation, adherence, and retention remain low. This systematic literature review synthesized evidence about individual and contextual factors affecting ART use among HIV-infected pregnant and postpartum women. METHODS Searches were conducted for studies addressing the population (HIV-infected pregnant and postpartum women), intervention (ART), and outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. Individual and contextual enablers and barriers to ART use were extracted and organized thematically within a framework of individual, interpersonal, community, and structural categories. RESULTS Thirty-four studies were included in the review. Individual-level factors included both those within and outside a woman's awareness and control (e.g., commitment to child's health or age). Individual-level barriers included poor understanding of HIV, ART, and prevention of mother-to-child transmission, and difficulty managing practical demands of ART. At an interpersonal level, disclosure to a spouse and spousal involvement in treatment were associated with improved initiation, adherence, and retention. Fear of negative consequences was a barrier to disclosure. At a community level, stigma was a major barrier. Key structural barriers and enablers were related to health system use and engagement, including access to services and health worker attitudes. CONCLUSIONS To be successful, programs seeking to expand access to and continued use of ART by integrating maternal health and HIV services must identify and address the relevant barriers and enablers in their own context that are described in this review. Further research on this population, including those who drop out of or never access health services, is needed to inform effective implementation.
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Affiliation(s)
- Ian Hodgson
- Independent Consultant, Bingley, United Kingdom
| | | | - Sarah N. Konopka
- Center for Health Services, Management Sciences for Health, Arlington, Virginia, USA
| | - Christopher J. Colvin
- Centre for Infectious Disease Epidemiology and Research (CIDER), Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edna Jonas
- Center for Health Services, Management Sciences for Health, Arlington, Virginia, USA
| | - Jennifer Albertini
- United States Agency for International Development (USAID)/Africa Bureau, Washington, D.C., USA
| | - Anouk Amzel
- USAID/Bureau for Global Health (BGH)/Office of HIV/AIDS, Washington, D.C., USA
| | - Karen P. Fogg
- USAID/BGH/Office of Health, Infectious Diseases, and Nutrition, Washington, D.C., USA
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Mate KS, Salinas G. Flipping primary health care: A personal story. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2014; 2:280-3. [PMID: 26250637 DOI: 10.1016/j.hjdsi.2014.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/15/2014] [Accepted: 10/02/2014] [Indexed: 10/24/2022]
Abstract
There is considerable interest in ideas borrowed from education about "flipping the classroom" and how they might be applied to "flipping" aspects of health care to reach the Triple Aim of improved health outcomes, improved experience of care, and reduced costs. There are few real-life case studies of "flipping health care" in practice at the individual patient level. This article describes the experience of one of the authors as he experienced having to "flip" his primary health care. We describe seven inverted practices in his care, report outcomes of this experiment, describe the enabling factors, and derive lessons for patient-centered primary care redesign.
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Affiliation(s)
- Kedar S Mate
- Department of Medicine, Weill Cornell Medical College, 525 E. 68th Street, NY, New York 10065, USA.
| | - Gilbert Salinas
- Rancho Los Amigos National Rehabilitation Center, Los Angeles County
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Abstract
INTRODUCTION Access to antiretroviral treatment (ART) has substantially improved over the past decade. In this new era of HIV as a chronic disease, the continued success of ART will depend critically on sustained high ART adherence. The objective of this review was to systematically review interventions that can improve adherence to ART, including individual-level interventions and changes to the structure of ART delivery, to inform the evidence base for the 2013 WHO consolidated antiretroviral guidelines. DESIGN A rapid systematic review. METHODS We conducted a rapid systematic review of the global evidence on interventions to improve adherence to ART, utilizing pre-existing systematic reviews to identify relevant research evidence complemented by screening of databases for articles published over the past 2 years on evidence from randomized controlled trials (RCTs). We searched five databases for both systematic reviews and primary RCT studies (Cochrane Library, EMBASE, MEDLINE, Web of Science, and WHO Global Health Library); we additionally searched ClinicalTrials.gov for RCT studies. We examined intervention effectiveness by different study characteristics, in particular, the specific populations who received the intervention. RESULTS A total of 124 studies met our selection criteria. Eighty-six studies were RCTs. More than 20 studies have tested the effectiveness of each of the following interventions, either singly or in combination with other interventions: cognitive-behavioural interventions, education, treatment supporters, directly observed therapy, and active adherence reminder devices (such as mobile phone text messages). Although there is strong evidence that all five of these interventions can significantly increase ART adherence in some settings, each intervention has also been found not to produce significant effects in several studies. Almost half (55) of the 124 studies investigated the effectiveness of combination interventions. Combination interventions tended to have effects that were similar to those of single interventions. The evidence base on interventions in key populations was weak, with the exception of interventions for people who inject drugs. CONCLUSION Tested and effective adherence-enhancing interventions should be increasingly moved into implementation in routine programme and care settings, accompanied by rigorous evaluation of implementation impact and performance. Major evidence gaps on adherence-enhancing interventions remain, in particular, on the cost-effectiveness of interventions in different settings, long-term effectiveness, and effectiveness of interventions in specific populations, such as pregnant and breastfeeding women.
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Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health 2014; 35:399-421. [PMID: 24387091 DOI: 10.1146/annurev-publhealth-032013-182354] [Citation(s) in RCA: 469] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past half-century, community health workers (CHWs) have been a growing force for extending health care and improving the health of populations. Following their introduction in the 1970s, many large-scale CHW programs declined during the 1980s, but CHW programs throughout the world more recently have seen marked growth. Research and evaluations conducted predominantly during the past two decades offer compelling evidence that CHWs are critical for helping health systems achieve their potential, regardless of a country's level of development. In low-income countries, CHWs can make major improvements in health priority areas, including reducing childhood undernutrition, improving maternal and child health, expanding access to family-planning services, and contributing to the control of HIV, malaria, and tuberculosis infections. In many middle-income countries, most notably Brazil, CHWs are key members of the health team and essential for the provision of primary health care and health promotion. In the United States, evidence indicates that CHWs can contribute to reducing the disease burden by participating in the management of hypertension, in the reduction of cardiovascular risk factors, in diabetes control, in the management of HIV infection, and in cancer screening, particularly with hard-to-reach subpopulations. This review highlights the history of CHW programs around the world and their growing importance in achieving health for all.
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Ribeiro C, Sarmento E Castro R, Dinis-Ribeiro M, Fernandes L. Effectiveness of Psycho-Educational Intervention in HIV Patients' Treatment. Front Psychiatry 2014; 5:198. [PMID: 25642197 PMCID: PMC4295437 DOI: 10.3389/fpsyt.2014.00198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 12/26/2014] [Indexed: 11/16/2022] Open
Abstract
Adherence to Highly Active Antiretroviral Therapy (HAART) is the main prognostic factor associated with HIV disease progression and death. The aim was to evaluate the effectiveness of a psycho-educational program to promote adherence to HAART in HIV patients. A longitudinal study (n = 102) over 9 months in an Infectious Diseases Hospital was carried out. Adherence to HAART was measured with standardized scales and values of viral load. Two groups were defined: adherents and non-adherents. In the latter, a psycho-educational program was implemented and 6 months later measured adherence to HAART. Knowledge about the infection, CD4 T lymphocytes and HIV-ribonucleic acid values were measured before and after this program. The sample was predominantly male (70%), heterosexual (78%), with a mean age of 49 (SD = 12.7) years, and 48% of participants were not adhering to HAART. After the program, non-adherence decreased to 21.6%. Knowledge about the infection increased from 79 to 97%. A significant increase in CD4 T lymphocytes (mean 540-580) and a decrease in viral load (mean 5411-3052) were observed, the latter of statistical significance. This program seems to be feasible and efficient, improving adherence to HAART.
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Affiliation(s)
- Clarisse Ribeiro
- Hospital Joaquim Urbano (Centro Hospitalar do Porto, EPE) , Porto , Portugal
| | | | - Mário Dinis-Ribeiro
- Biostatistics and Medical Informatics Service and Centre for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto , Porto , Portugal
| | - Lia Fernandes
- Research and Education Unit on Ageing (UNIFAI) and Centre for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto , Porto , Portugal
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Kenya S, Jones J, Arheart K, Kobetz E, Chida N, Baer S, Powell A, Symes S, Hunte T, Monroe A, Carrasquillo O. Using community health workers to improve clinical outcomes among people living with HIV: a randomized controlled trial. AIDS Behav 2013; 17:2927-34. [PMID: 23515640 DOI: 10.1007/s10461-013-0440-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIDS-related mortality remains a leading cause of preventable death among African-Americans. We sought to determine if community health workers could improve clinical outcomes among vulnerable African-Americans living with HIV in Miami, Florida. We recruited 91 medically indigent persons with HIV viral loads ≥1,000 and/or a CD4 cell count ≤350. Patients were randomized to a community health worker (CHW) intervention or control group. Viral load and CD4 cell count data were abstracted from electronic medical records. At 12 months, the mean VL in the intervention group was log 0.9 copies/μL lower than the control group. The CD4 counts were not significantly different among the groups. Compared to the control group, patients randomized to CHWs experienced statistically significant improvements in HIV viral load. Larger multi-site studies of longer duration are needed to determine whether CHWs should be incorporated into standard treatment models for vulnerable populations living with HIV.
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Peltzer K, Ramlagan S, Jones D, Weiss SM, Fomundam H, Chanetsa L. Efficacy of a lay health worker led group antiretroviral medication adherence training among non-adherent HIV-positive patients in KwaZulu-Natal, South Africa: results from a randomized trial. SAHARA J 2013; 9:218-26. [PMID: 23234350 DOI: 10.1080/17290376.2012.745640] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
There is a lack of theory-based randomized controlled trials to examine the effect of antiretroviral adherence in sub-Saharan Africa. We assessed the effectiveness of a lay health worker lead structured group intervention to improve adherence to antiretroviral therapy (ART) in a cohort of HIV-infected adults. This two-arm randomized controlled trial was undertaken at an HIV clinic in a district hospital in South Africa. A total of 152 adult patients on ART and with adherence problems were randomized 1:1 to one of two conditions, a standard adherence intervention package plus a structured three session group intervention or to a standard adherence intervention package alone. Self-reported adherence was measured using the Adult AIDS Clinical Trials Group adherence instrument prior to, post intervention and at follow-up. Baseline characteristics were similar for both conditions. At post-intervention, adherence information knowledge increased significantly in the intervention condition in comparison to the standard of care, while adherence motivation and skills did not significantly change among the conditions over time. There was a significant improvement in ART adherence and CD4 count and a significant reduction of depression scores over time in both conditions, however, no significant intervention effect between conditions was found. Lay health workers may be a useful adjunct to treatment to enhance the adherence information component of the medication adherence intervention, but knowledge may be necessary but not sufficient to increase adherence in this sample. Psychosocial informational interventions may require more advanced skill training in lay health workers to achieve superior adherence outcomes in comparison standard care in this resource-constrained setting.
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Abstract
Racial and ethnic health disparities are a national health issue. They are well described in other chronic diseases, but in rheumatoid arthritis (RA), research into their causes, outcomes, and elimination is in its early stages. Health disparities occur in a complex milieu, with system-level, provider-level, and individual-level factors playing roles. Dissecting the overlapping aspects of race/ethnicity, socioeconomic variables, and how their individual components combine to explain the magnitude of disparities in RA can be challenging. Recent research has focused on the extent to which treatment preferences, adherence, trust in physicians, patient-physician communication, health literacy, and depression have contributed to observed disparities in RA. Practicing evidence-based medicine, improving patient-physician communication skills, reducing language and literacy barriers, improving adherence to therapies, raising awareness of racial/ethnic disparities, and recognizing comorbidities such as depression are steps clinicians may take to help eliminate racial/ethnic disparities in RA.
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Affiliation(s)
- Christine A McBurney
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, 3500 Terrace St., S720A BST, Pittsburgh, PA 15261, USA.
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Amico KR, Orrell C. Antiretroviral therapy adherence support: recommendations and future directions. J Int Assoc Provid AIDS Care 2013; 12:128-37. [PMID: 23334155 DOI: 10.1177/1545109712459041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dramatic increases in the evidence-base for intervention approaches to support antiretroviral therapy (ART) adherence have resulted in numerous reviews, syntheses, and guidelines/recommendations. This review characterizes the current state of the literature and identifies areas in need of additional targeted focus to better align research and practice. Leading recommendations for the process of intervention development (relevant to both rigorous research and real-world intervention planning) and strategies to consider in working with individuals, communities, and systems are provided. In order to move systematically toward the identification of what kinds of interventions work best for whom and when, attending to both intervention outcomes and "drivers" of observed effects or lack of effects in controlled research is critically important. Further, evidence emerging from practice should be aggressively added to research agendas to promote better synergies between the practice and research communities.
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Affiliation(s)
- K Rivet Amico
- Center for Health, Intervention and Prevention, University of Connecticut, Storrs, CT 06269, USA.
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Elzarrad MK, Eckstein ET, Glasgow RE. Applying chronic illness care, implementation science, and self-management support to HIV. Am J Prev Med 2013; 44:S99-107. [PMID: 23253770 DOI: 10.1016/j.amepre.2012.09.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/04/2012] [Accepted: 09/19/2012] [Indexed: 10/27/2022]
Affiliation(s)
- M Khair Elzarrad
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland 20852, USA
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Roth AM, Holmes AM, Stump TE, Aalsma MC, Ackermann RT, Carney TS, Katz BP, Kesterson J, Erdman SM, Balt CA, Inui TS. Can lay health workers promote better medical self-management by persons living with HIV? An evaluation of the Positive Choices program. PATIENT EDUCATION AND COUNSELING 2012; 89:184-190. [PMID: 22770948 DOI: 10.1016/j.pec.2012.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 04/24/2012] [Accepted: 06/06/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate Positive Choices (PC), a program that employed lay health workers to motivate antiretroviral adherence among persons living with HIV with coverage from Indiana's high-risk insurance pool. METHODS Four hundred and forty nine participants living in the greater Indianapolis area were randomly allocated to treatment (n = 91) or control (n = 358) groups and followed for one year. RESULTS Compared to control subjects, PC subjects were more likely to adhere to HIV medications (medication possession ratio adherence ≥ 0.95, OR = 1.83, p = 0.046), and to achieve undetectable viral load (<50 copies/mL, OR = 2.01, p = 0.011) in the 12 months following introduction of PC. There were no significant differences observed between groups in any of self-reported health status indicators. CONCLUSION Estimates suggest that PC clients were 16% more likely to have undetectable viral loads than clients in standard care. The incremental program cost was approximately $10,000 for each additional person who achieved an undetectable viral load. PRACTICE IMPLICATIONS As persons living with HIV experience greater longevity and healthcare reform expands coverage to these high-risk populations, greater demands will be placed on the HIV-care workforce. Results suggest lay health workers may serve as effective adjuncts to professional care providers.
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Affiliation(s)
- Alexis M Roth
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, USA.
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