Can community health workers improve adherence to highly active antiretroviral therapy in the USA? A review of the literature

Abstract

Objectives Highly active antiretroviral therapy (HAART) has transformed HIV infection into a manageable chronic illness, yet AIDS mortality among ethnic minorities persists in the USA. HAART nonadherence is associated with increased HIV viral load, low CD4 cell count and racial disparities in HIV outcomes. While there is no universal consensus on how to improve medical adherence in HIV‐positive populations, the community health worker (CHW) model is emerging as an effective strategy to overcome barriers to HAART adherence. Although utilized in international settings, there is little evidence regarding the effects of CHWs on HIV outcomes in the USA. Methods We performed a comprehensive search from May 2010 to November 2010 to identify studies carried out in the USA that utilized CHWs to improve HAART adherence and measured HIV viral loads and CD4 cell counts to assess intervention effects. Sixteen studies met the inclusion criteria and were reviewed for this article. All studies reported clinical HIV outcomes. Results Interventions that lasted at least 24 weeks, provided frequent contact with participants, and focused on medication management were associated with improved HAART adherence, as indicated by reduced HIV viral load and increased CD4 cell count. Conclusions Compared with current standards of care, CHW programmes may offer a practical and cost‐effective alternative to improve HAART adherence, which may lead to reduced HIV viral load and increased CD4 cell counts among HIV‐positive populations in the USA.

Systematic review of physical activity promotion by community health workers

“…CHW can be involved in specific interventions to reduce the impact of diseases such as diabetes mellitus (Little et al, 2014), in programs for immunization and maternal/child health (Corluka et al, 2009;Lewin et al, 2010;Patel and Nowalk, 2010), HIV/AIDS (Kenya et al, 2011) and in actions for health promotion or lifestyle improvements (United States Department of Health and Human Services.,…”

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

“…[1][2][3] As value-based payment models expand, providers will have more flexibility to fund CHWs with global budgets, or payers may elect to reimburse for CHW services. [4][5][6] The emerging evidence base on CHW programs 7 for the prevention and management of chronic diseases includes systematic reviews concluding that CHW interventions can improve overall health outcomes 8 and outcomes for patients with heart disease, stroke, 9 type II diabetes, [10][11][12] HIV, 13 and asthma 2,14 and for vulnerable patients with or at risk for a variety of chronic diseases or cancer. 15 Other systematic reviews have also documented the costs and cost-effectiveness of CHW programs, 15 but none, outside of low and middle-income countries, 16 have examined the impact of CHWs on the utilization of health services by patients with chronic conditions.…”

Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review

“…Of the three studies focused on colorectal cancer, only one yielded a significant increase in colorectal cancer screening in the CBHW-led education group compared with usual care (27% vs. 12%, p<0.001). 45 The studies without significant changes in mammogram, 27,36,53,55 Pap test, 27,30,32,34 or colorectal cancer screening 21,27 tended to compare one type of CBHW intervention to another (e.g., education vs social support group) 27 or to a less intensive intervention (as opposed to no intervention). 27,53 In addition, some of these studies included a high proportion of participants who were up-to-date for screening 41 or had significantly different demographic characteristics between the two groups at baseline.…”