title: Can lay health workers promote better medical self-management by persons living with HIV? An evaluation of the Positive Choices program.
abstract: OBJECTIVE
  To evaluate Positive Choices (PC), a program that employed lay health workers to motivate antiretroviral adherence among persons living with HIV with coverage from Indiana's high-risk insurance pool.
  
  
  METHODS
  Four hundred and forty nine participants living in the greater Indianapolis area were randomly allocated to treatment (n = 91) or control (n = 358) groups and followed for one year.
  
  
  RESULTS
  Compared to control subjects, PC subjects were more likely to adhere to HIV medications (medication possession ratio adherence ≥ 0.95, OR = 1.83, p = 0.046), and to achieve undetectable viral load (<50 copies/mL, OR = 2.01, p = 0.011) in the 12 months following introduction of PC. There were no significant differences observed between groups in any of self-reported health status indicators.
  
  
  CONCLUSIONS
  Estimates suggest that PC clients were 16% more likely to have undetectable viral loads than clients in standard care. The incremental program cost was approximately $10,000 for each additional person who achieved an undetectable viral load.
  
  
  CONCLUSIONS
  As persons living with HIV experience greater longevity and healthcare reform expands coverage to these high-risk populations, greater demands will be placed on the HIV-care workforce. Results suggest lay health workers may serve as effective adjuncts to professional care providers.
authors: Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, USA. almroth@iupui.edu
authors: Alexis M
authors: AM
authors: Roth
authors: Ann M
authors: AM
authors: Holmes
authors: Timothy E
authors: TE
authors: Stump
authors: Matthew C
authors: MC
authors: Aalsma
authors: Ronald T
authors: RT
authors: Ackermann
authors: Theodore S
authors: TS
authors: Carney
authors: Barry P
authors: BP
authors: Katz
authors: Joseph
authors: J
authors: Kesterson
authors: Sharon M
authors: SM
authors: Erdman
authors: Christine A
authors: CA
authors: Balt
authors: Thomas S
authors: TS
authors: Inui
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002755:Choice Behavior; D003150:Community Health Workers; D037001:Directive Counseling; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007196:Indiana; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D012648:Self Care; D012944:Social Support; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents