Integrating community health workers into HIV care teams: Impact on HIV care outcomes

Drainoni, Mari-Lynn; Baughman, Allyson; Bachman, Sara S.; Bowers-Sword, Rachel; Davoust, Melissa; Fortu, Karen; Ni, Pengsheng; Rajabiun, Serena; Rojo, Maria Campos; Wolfe, Hill L.; Martínez, Linda Sprague

doi:10.1080/15381501.2020.1785364

Cited by 19 publications

(26 citation statements)

References 37 publications

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“…Beyond technical assistance to facilitate implementation sites received funding to support the salaries of CHW and CHW supervisor staff as well as travel to all-site in person meetings. Outcome assessment (18) and ongoing process evaluation was conducted to examine the CHW integration process across sites. A description of the sites as well as outcomes has been published elsewhere (18).…”

Section: States (Us)mentioning

confidence: 99%

“Part of Getting to Where We Are is Because We Have Been Open to Change”Integrating Community Health Workers on Care Teams at Ten Ryan White HIV/AIDS Program Recipient Sites

Martínez

Davoust

Rajabiun

et al. 2021

Preprint

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Background: Community Health Workers (CHWs) have long been integrated in the delivery of HIV care, in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes.There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. Methods: Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n=20). Findings: Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and TA strategies. Conclusions: Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for health care organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW implementation. The integration of the CHW role may present an occasion for health care delivery organizations to reassess policies that may unintentionally marginalize communities and both limit career opportunities and patient engagement.

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Section: States (Us)mentioning

confidence: 99%

“Part of Getting to Where We Are is Because We Have Been Open to Change”Integrating Community Health Workers on Care Teams at Ten Ryan White HIV/AIDS Program Recipient Sites

Martínez

Davoust

Rajabiun

et al. 2021

Preprint

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“…CHWs have a long history in HIV care [13], particularly in middle-and low-income countries [14][15][16]. Studies to date indicate that CHWs can improve adherence to antiretroviral therapy [17,18], psychosocial outcomes [19], and access to social resources that influence treatment seeking, health and well-being [18]. There is a need for more research related to strategies that promote the successful integration of CHWs into HIV care delivery systems.…”

Section: Introductionmentioning

confidence: 99%

“…Through the training program and learning sessions, the implementation process was studied and final lessons and adaptations were incorporated in an implementation guide. Outcome assessment [ 18 ] and ongoing process evaluation was conducted to examine the CHW integration process across sites. A description of the sites as well as outcomes has been published elsewhere [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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“Part of getting to where we are is because we have been open to change” integrating community health workers on care teams at ten Ryan White HIV/AIDS program recipient sites

et al. 2021

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Background Community Health Workers (CHWs) have long been integrated in the delivery of HIV care in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US-based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes. There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. Methods Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n = 20). Findings Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and Technical Assistance strategies. Conclusions Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for healthcare organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW program implementation. The integration of the CHWs in the delivery of HIV care requires clearly distinguishing their role from the roles of other members of the healthcare delivery team.

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“…There is emerging evidence that CHWs, including patient navigators and peer educators, as members of the HIV workforce can effectively link and retain people with HIV in care and improve viral suppression. (3,4) By functioning as a bridge between the community and health care system, CHWs have the potential to address the structural inequities and reduce the stigma, discrimination and other barriers that prevent people at risk for and living with HIV from seeking and staying in care and adhering to treatment. (5) Though prior studies demonstrate the potential of CHW support services to improve HIV outcomes, few resources exist to guide the process of integrating CHWs into care teams in a clinical setting.…”

Section: Introductionmentioning

confidence: 99%

A Participatory Curricula for Community Health Workers and Supervisors to Increase HIV Health Outcomes

Rajabiun

Baughman

Sullivan

et al. 2021

Front. Public Health

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Community Health Workers (CHWs) are becoming essential members of the HIV workforce as emerging evidence demonstrates their effectiveness in engaging people with HIV into care and treatment. In 2018, among the estimated 37,000 persons who received an HIV diagnosis, the majority were from racial ethnic minority communities. CHWs serve as a bridge between the community and health care system and have the potential to address structural inequities and reduce the stigma, discrimination and other barriers that prevent people with HIV from seeking and staying in care and treatment. Effective CHW integration into the HIV primary care team requires a training and supervision system that is culturally responsive to the complex social and medical needs of people with HIV. This article describes a comprehensive training approach and curricula for CHWs and supervisors and its impact on the health care team. Grounded in a Popular Education model and using the CHW core consensus competency (C3) framework, a team of experts in HIV, training and supervision, including CHWs working in HIV care and treatment developed an 80-h CHW and 20-h supervisor curricula. The trainings were delivered via in-person and virtual sessions over the course of 2 years. Using a mixed method evaluation, 23 CHWs and 22 supervisors across 10 clinic sites in eight states participated in the training sessions. Measures included knowledge and confidence related to HIV-specific content, supporting clients with managing stigma and discrimination, ability to communicate with other team members and helping clients navigate the services system. CHWs reported improved skills with documentation in the electronic health record, helping clients with treatment adherence challenges and educating on lab results. Supervisors reported learning strategies for assigning clients to CHWs, self-care techniques, providing strengths-based feedback, and mentoring and coaching. The participatory practice-based curricula allowed supervisors and CHWs to share experiences and solicit input from peers for problem resolution and implementation of new policies and practices. This training approach focused on HIV specific content with core competency training could serve as a model for CHWs working in primary care settings and with populations experiencing multiple chronic health conditions and social needs.

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Integrating community health workers into HIV care teams: Impact on HIV care outcomes

Cited by 19 publications

References 37 publications

“Part of Getting to Where We Are is Because We Have Been Open to Change”Integrating Community Health Workers on Care Teams at Ten Ryan White HIV/AIDS Program Recipient Sites

“Part of Getting to Where We Are is Because We Have Been Open to Change”Integrating Community Health Workers on Care Teams at Ten Ryan White HIV/AIDS Program Recipient Sites

“Part of getting to where we are is because we have been open to change” integrating community health workers on care teams at ten Ryan White HIV/AIDS program recipient sites

A Participatory Curricula for Community Health Workers and Supervisors to Increase HIV Health Outcomes

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