Original Paper

AIDS and Behavior

, Volume 17, Issue 9, pp 2927-2934

First online:

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

  • Sonjia KenyaAffiliated withDivision of General Medicine, Jay Weiss Center Social Medicine and Health Equity, University of Miami Miller School of Medicine Email author 
  • , Jamal JonesAffiliated withJay Weiss Center for Social Medicine and Health Equity, University of Miami Miller School of Medicine
  • , Kristopher ArheartAffiliated withDepartment of Epidemiology and Public Health, University of Miami Miller School of Medicine
  • , Erin KobetzAffiliated withDepartment of Epidemiology and Public Health, Jay Weiss Center for Social Medicine and Health Equity, University of Miami Miller School of Medicine
  • , Natasha ChidaAffiliated withJay Weiss Center for Social Medicine and Health Equity, University of Miami Miller School of Medicine
  • , Shelly BaerAffiliated withDepartment of Pediatrics, Mailman Center for Child Development, University of Miami Miller School of Medicine
  • , Alexis PowellAffiliated withDivision of Infectious Diseases, University of Miami Miller School of Medicine
  • , Stephen SymesAffiliated withDivision of Infectious Diseases, Jay Weiss Center Social Medicine and Health Equity, University of Miami Miller School of Medicine
  • , Tai HunteAffiliated withJay Weiss Center for Social Medicine and Health Equity, University of Miami Miller School of Medicine
    • , Anne MonroeAffiliated withJay Weiss Center for Social Medicine and Health Equity, University of Miami Miller School of Medicine
    • , Olveen CarrasquilloAffiliated withDivision of General Medicine, Jay Weiss Center Social Medicine and Health Equity, University of Miami Miller School of Medicine

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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.

Keywords

Community health workers HIV viral load African-Americans HIV disparities

Resumen

La mortalidad relacionada con el SIDA sigue siendo la principal causa de muerte evitable entre los afro-americanos. Nuestro objetivo era determinar si los promotores de salud podrían mejorar los resultados clínicos entre africano-americanos que viven con el VIH en Miami, Florida. Reclutamos a noventa y un personas médicamente indigentes con cargas virales de VIH >1,000 y/o un recuento de células CD4 <350. Los pacientes fueron asignados al azar a un grupo de intervención con un trabajador de salud comunitaria (TSC)/promotor o al grupo control. Los datos de carga viral y recuento de células CD4 fueron extraídos de registros médicos electrónicos. En doce meses, el promedio del VL en el grupo de intervención fué de 0,9 log copias/μL más bajos que los del grupo control. Los recuentos de células CD4 no fueron significativamente diferentes entre los grupos. En comparación con el grupo control, los pacientes asignados al azar a los promotores/TSC experimentaron mejoras estadísticamente significativas en la carga viral de VIH. Estudios de mayor duración y de sitios múltiples son necesarios para determinar si los promotores/TSC deben ser incorporados en los modelos estándar de tratamiento para las poblaciones vulnerables que viven con el VIH.