Using Community Health Workers to Improve Clinical Outcomes Among People Living with HIV: A Randomized Controlled Trial

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.

Variation in Networks and Forms of Support for Care‐Seeking Across the HIV Care Continuum in the Rural Southeastern United States

“…The practical implications of this study extend to the design of programs aimed at reducing the burden of HIV care disparities experienced by PLWH in rural Southern environments. As documented in previous research and in the current findings, informal and formal networks have the ability to provide specialized support resources, from HIV diagnosis to medication adherence . The inclusion of trusted family members in the practice sphere may be critical to facilitating expedient entry into care and greater emotional stability after diagnosis.…”

“…As documented in previous research and in the current findings, informal and formal networks have the ability to provide specialized support resources, from HIV diagnosis to medication adherence. 18,37,38 The inclusion of trusted family members in the practice sphere may be critical to facilitating expedient entry into care and greater emotional stability after diagnosis. Although disclosure interventions are increasingly implemented in a variety of practice settings, 39 it is equally important for HIV counseling programs to advise and educate family members on the best ways to support newly diagnosed PLWH.…”

Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care

“…Of principal concern was the apparent low‐to‐moderate quality of the majority of studies, meaning that any policy recommendations for implementation must be made with extreme caution until further, high‐quality studies have been conducted and adequately reported. Age definitions of adolescence varied widely between studies, and some studies that included adolescent participants were excluded because the majority of participants were not aged between 10 and 19 years, or we were unable to extract data for this age group . In informal review of these studies, most of the interventions assessed were broadly similar to those included in the review and also had low methodological and/or reporting quality.…”

Monitoring HIV Prevention Programme Outcomes among Key Populations in Kenya: Findings from a National Survey

“…HIV prevention programmes must ensure that services for STI treatment, HIV testing are accessible and acceptable for KPs, so that, higher proportions of KP members access these services. Previous research in Kenya has indicated that the use of community health workers can substantially increase utilization of health services for maternal and newborn health [ 19 ] and HIV treatment [ 20 ], and this may also be a beneficial strategy to enhance national HIV prevention efforts.…”