title: 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.
authors.affiliation: Division of General Medicine, Jay Weiss Center Social Medicine and Health Equity, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Suite 801, Miami, FL, 33136, USA, skenya@med.miami.edu.
authors.forename: Sonjia
authors.initials: S
authors.lastname: Kenya
authors.forename: Jamal
authors.initials: J
authors.lastname: Jones
authors.forename: Kristopher
authors.initials: K
authors.lastname: Arheart
authors.forename: Erin
authors.initials: E
authors.lastname: Kobetz
authors.forename: Natasha
authors.initials: N
authors.lastname: Chida
authors.forename: Shelly
authors.initials: S
authors.lastname: Baer
authors.forename: Alexis
authors.initials: A
authors.lastname: Powell
authors.forename: Stephen
authors.initials: S
authors.lastname: Symes
authors.forename: Tai
authors.initials: T
authors.lastname: Hunte
authors.forename: Anne
authors.initials: A
authors.lastname: Monroe
authors.forename: Olveen
authors.initials: O
authors.lastname: Carrasquillo
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003150:Community Health Workers / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D015397:Program Evaluation; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D019562:Viral Load; D016903:Drug Monitoring