Center for Innovation in Social Work in Health, Boston University School of Social Work, 264 Baystate Road, Boston, MA, 02215, USA.
Department of Health Law, Policy and Management at Boston University School of Public Health, Boston, USA.
BMC Public Health. 2021 May 14;21(1):922. doi: 10.1186/s12889-021-10943-1.
Community Health Workers (CHWs) have long been integrated in the delivery of HIV care in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US-based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes. There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities.
Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n = 20).
Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and Technical Assistance strategies.
Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for healthcare organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW program implementation. The integration of the CHWs in the delivery of HIV care requires clearly distinguishing their role from the roles of other members of the healthcare delivery team.
社区卫生工作者（CHW）长期以来一直被整合到中低收入国家的艾滋病毒护理中。然而，人们对 CHW 整合到美国（美国）艾滋病毒护理团队中的情况知之甚少。迄今为止，美国的 CHW 整合研究探索了在初级保健和以患者为中心的医疗之家背景下的整合。需要研究促进 CHW 成功整合到艾滋病毒护理提供系统中的策略。2016 年，卫生资源和服务管理局艾滋病毒/艾滋病局发起了一项为期三年的倡议，为瑞安怀特艾滋病毒/艾滋病计划（RWHAP）受援点提供培训、技术援助和评估，以将 CHW 整合到他们的多学科护理团队中，并进而加强他们接触有色人种社区和减少艾滋病毒不平等现象的能力。
从八个州中选择了十个 RWHAP 地点。多地点方案评估包括以 RE-AIM 为指导的过程评估，以了解组织如何将 CHW 纳入其护理团队。现场团队成员参加小组访谈，以在早期实施和项目期间了解该过程。采用定向内容分析来检查方案的实施情况。使用专家建议实施变革项目中概述的实施策略开发的代码应用于小组访谈（n=20）。
站点最常描述的实施策略与为将 CHW 整合到艾滋病毒护理团队中而进行的组织层面调整有关。这些策略包括修改、定义和区分专业角色以及改变组织政策。用于实施的策略，如网络编织、监督和促进适应性，是第二个最常提到的策略，其次是培训和技术援助策略。
在站点的实施经验中，存在一些对医疗保健组织构成挑战的潜在问题。组织政策和适应能力对于促进 CHW 计划的实施非常重要。CHW 在艾滋病毒护理中的整合需要明确区分他们的角色与医疗保健提供团队其他成员的角色。
