AIDS and Behavior

, Volume 17, Issue 9, pp 2927–2934

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

  • Sonjia Kenya
  • Jamal Jones
  • Kristopher Arheart
  • Erin Kobetz
  • Natasha Chida
  • Shelly Baer
  • Alexis Powell
  • Stephen Symes
  • Tai Hunte
  • Anne Monroe
  • Olveen Carrasquillo
Original Paper

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.

References

  1. 1.
    Centers for Disease Control and Prevention (CDC): HIV/AIDS in the United States. http://www.cdc.gov/hiv/resources/factsheets/us.htm (2008). Accessed 24 Jul 2009.
  2. 2.
    Crum NF, Riffenburgh RH, Wegner S, et al. Comparisons of causes of death and mortality rates among HIV infected patients. Analysis of the pre-, early, and late HAART eras. J Acquir Immune Defic Syndr. 2006;41:194–200.PubMedCrossRefGoogle Scholar
  3. 3.
    CDC: Cases of HIV Infection and AIDS in the United States and dependent areas. http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2007report/table8.htm (2008). Accessed 10 Jul 2009.
  4. 4.
    CDC: HIV/AIDS among African Americans, Fact-Sheet. http://www.cdc.gov/HIV/topics/aa/resources/factsheets/pdf/aa.pdf (2008). Accessed 5 Mar 2009.
  5. 5.
    CDC: HIV among Latinos, Fact Sheet. http://www.cdc.gov/hiv/resources/factsheets/pdf/latino.pdf (2011). Accessed 7 Feb 2012.
  6. 6.
    UNAIDS update: AIDS epidemic update regional summary. http://data.unaids.org/pub/Report/2008/jc1532_epibriefs_namerica_europe_en.pdf (2008). Accessed 10 Jul 2009.
  7. 7.
    Florida Department of Health, Miami-Dade County: AIDS/HIV among Blacks in Miami/Dade. http://www.dadehealth.org/downloads/FS_2007_BLACKS.pdf (2007). Accessed 10 Feb 2009.
  8. 8.
    World Health Organization (WHO). Adherence to long-term therapies: evidence for action. Geneva: WHO; 2003.Google Scholar
  9. 9.
    Centers for Disease Control: Diagnoses of HIV Infection and AIDS in the United States and Dependent Areas, 2009. http://www.cdc.gov/hiv/surveillance/resources/reports/2009report/index.htm (2011). Accessed 7 Feb 2012.
  10. 10.
    Health Council of South Florida: 2011 District 11 Health Profile: Miami-Dade County, Monroe County. http://www.healthcouncil.org/publications/District_Health_Profile_2011_02_09_2012.pdf (2011). Accessed 2 Mar 2012.
  11. 11.
    Kenya S, Chida N, Symes S, Shor-Posner G. Can community health workers improve adherence to highly active antiretroviral therapy in the USA. HIV Med. 2011;12(9):525–34.PubMedCrossRefGoogle Scholar
  12. 12.
    Farmer P, Léandre F, Mukherjee JS, et al. Community-based approaches to HIV treatment in resource-poor settings. Lancet. 2001;358:404–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Farmer P, Léandre F, Mukherjee J, Gupta R, Tarter L, Kim JY. Community-based treatment of advanced HIV disease: introducing DOTHAART (directly observed therapy with highly active antiretroviral therapy). Bull World Health Organ. 2001;79:1145–51.PubMedGoogle Scholar
  14. 14.
    Behforouz H, Farmer P, Mukherjee J. From directly observed therapy to accompagnateurs: enhancing AIDS treatment outcomes in Haiti and in Boston enhancing adherence to AIDS treatment. CID. 2004;38(Suppl 5):S429–36.CrossRefGoogle Scholar
  15. 15.
    Macalino GE, Hogan JW, Mitty JA, et al. A randomized clinical trial of community-based directly observed therapy as an adherence intervention for HAART among substance users. AIDS. 2007;21:1473–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Smith-Rohrberg D, Mezger J, Walton M, Bruce RD, Altice FL. Impact of enhanced services on virologic outcomes in a directly administered antiretroviral therapy trial for HIV-injected drug users. J Acquir Immune Defic Syndr. 2006;43:S48–53.PubMedCrossRefGoogle Scholar
  17. 17.
    Visnegarwala F, Rodriguez-Barradass MC, Graviss EA, Caprio M, Nykyforchyn M, Laufman L. Community outreach with weekly delivery of anti-retroviral drugs compared to cognitive-behavioral health care team-based approach to improve adherence among indigent women newly starting HAART. AIDS Care. 2006;8:332–8.CrossRefGoogle Scholar
  18. 18.
    Khanlou H, Vijayabhaskar RK, Yeh V, et al. Pilot study of directly observed therapy in highly nonadherent HIV-infected patients in an urban community-based institution. J Acquir Immune Defic Syndr. 2003;33:651–3.PubMedCrossRefGoogle Scholar
  19. 19.
    Babamoto KS, Sey KA, Camilleri AJ, Karlan VJ, Catalasan J, Morisky DE. Improving diabetes care and health measures among hispanics using community health workers results from a randomized controlled trial. Health Educ Behav. 2009;36(1):113–26.PubMedCrossRefGoogle Scholar
  20. 20.
    Parker EA, Israel BA, Robins TG, et al. Evaluation of community action against asthma: a community health worker intervention to improve children’s asthma-related health by reducing household environmental triggers for asthma. Health Educ Behav. 2008;35(3):376–95.PubMedCrossRefGoogle Scholar
  21. 21.
    Brownstein JN, Chowdhury FM, Norris SL, et al. Effectiveness of community health workers in the care of people with hypertension. Am J Prev Med. 2007;32(5):435–47.PubMedCrossRefGoogle Scholar
  22. 22.
    Smith Fawzi MC, Jagannathan P, Cabral J, et al. Limitations in knowledge of HIV transmission among HIV-positive patients accessing case management services in a resource-poor setting. AIDS Care. 2006;18(7):764–71.PubMedCrossRefGoogle Scholar
  23. 23.
    Lifeline Program for Low-Income Consumers. http://www.fcc.gov/lifeline. Accessed 8 Jan 2013.
  24. 24.
    Behforouz HM, Kalmus A, Scherz CS, Kahn JS, Kadakia MB, Farmer PE. Directly observed therapy for HIV antiretroviral therapy in an Urban US setting. J Acquir Immune Defic Syndr. 2004;36:642–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Stenzel MS, McKenzie M, Mitty JA, Flanigan TP. Enhancing adherence to HAART: a pilot program of modified directly observed therapy. AIDS Read. 2001;11(317–9):324–8.Google Scholar
  26. 26.
    Sledjeski EM, Delahanty DL, Bogart LM. Incidence and impact of posttraumatic stress disorder and comorbid depression on adherence to HAART and CD4+ counts in People Living with HIV. AIDS Patient Care STDs. 2005;19(11):728–36.PubMedCrossRefGoogle Scholar
  27. 27.
    Ickovics JR, Hamburger ME, Vlahov D, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV epidemiology research study. JAMA. 2001;285(11):1466–74.PubMedCrossRefGoogle Scholar
  28. 28.
    Deeks SG, Phillips AN. HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ. 2009;338:288–92.CrossRefGoogle Scholar
  29. 29.
    Massachusetts General Hospital Disparities Solutions Center, using multi-disciplinary teams to address disparities: The use of culturally competent navigators, health coaches, and community health workers. http://www2.massgeneral.org/disparitiessolutions/z_files/dsc%20navigator_chw_5.20.08.pdf (2006). Accessed 6 Dec 2012.
  30. 30.
    Rahman SM, Ali NA, Jennings L, et al. Factors affecting recruitment and retention of community health workers in a newborn care intervention in Bangladesh. Hum Resour Health. 2010;8:12.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sonjia Kenya
    • 1
  • Jamal Jones
    • 2
  • Kristopher Arheart
    • 3
  • Erin Kobetz
    • 7
  • Natasha Chida
    • 2
  • Shelly Baer
    • 4
  • Alexis Powell
    • 5
  • Stephen Symes
    • 6
  • Tai Hunte
    • 2
  • Anne Monroe
    • 2
  • Olveen Carrasquillo
    • 1
  1. 1.Division of General MedicineJay Weiss Center Social Medicine and Health Equity, University of Miami Miller School of MedicineMiamiUSA
  2. 2.Jay Weiss Center for Social Medicine and Health Equity, University of Miami Miller School of MedicineMiamiUSA
  3. 3.Department of Epidemiology and Public HealthUniversity of Miami Miller School of MedicineMiamiUSA
  4. 4.Department of PediatricsMailman Center for Child Development, University of Miami Miller School of MedicineMiamiUSA
  5. 5.Division of Infectious DiseasesUniversity of Miami Miller School of MedicineMiamiUSA
  6. 6.Division of Infectious DiseasesJay Weiss Center Social Medicine and Health Equity, University of Miami Miller School of MedicineMiamiUSA
  7. 7.Department of Epidemiology and Public HealthJay Weiss Center for Social Medicine and Health Equity, University of Miami Miller School of MedicineMiamiUSA

Personalised recommendations