Department of Public Health, University of Massachusetts, Lowell, MA; and.
School of Social Work, University of Memphis, Memphis, TN.
J Acquir Immune Defic Syndr. 2022 Jul 1;90(S1):S65-S73. doi: 10.1097/QAI.0000000000002966.
Community health worker (CHW) interventions are an evidence-based practice adopted by health care settings to increase retention in care and viral suppression for people living with HIV (PLWH) from racial/ethnic minority communities. However, disparate funding, unclear roles vis a vis other care team members, limited training and promotion opportunities, and a lack of standards for wages and tasks limit the ability to effectively use CHWs as part of the health care team. Guided by the Exploration, Preparation, Implementation, and Sustainment and Reach, Effectiveness, Adoption, Implementation, and Maintenance frameworks, this study describes the key determinants for CHW integration and sustainability at 3 agencies in Shelby County, TN, to improve viral suppression and reduce disparities among rural and urban people living with HIV.
Memphis Transitional Grant Area (TGA) which includes 8 rural and urban counties in west Tennessee, Arkansas, and Mississippi.
Seventeen key informants were identified using purposeful and snowball sampling techniques, including community and agency leadership staff, frontline staff, and faith leaders.
Key determinants of CHW integration include establishing clear and standardized CHW roles within and across organizations, facilitating interorganizational networks, and leveraging funds for livable CHW wages and sustainable positions. Training strategies that strengthen the CHW workforce include content related to trauma-informed care, managing stress, and cultural humility.
Several inner and outer settings and innovation and bridging factors affect CHW positions. Data collected will inform the implementation and sustainment of future policies and interventions intended to improve HIV care continuum outcomes and reduce disparities for PLWH.
社区卫生工作者（CHW）干预措施是一种基于证据的实践，被医疗保健机构采用，以增加来自少数族裔社区的艾滋病毒感染者（PLWH）的护理保留率和病毒抑制率。然而，资金分配不均、与其他护理团队成员的角色不明确、培训和晋升机会有限，以及工资和任务标准缺乏，限制了有效利用 CHW 作为医疗保健团队的一部分的能力。本研究以探索、准备、实施和维持以及可达性、有效性、采用、实施和维持框架为指导，描述了田纳西州谢尔比县 3 家机构中 CHW 整合和可持续性的关键决定因素，以提高病毒抑制率并减少农村和城市 PLWH 之间的差异。
孟菲斯过渡性赠款区（TGA），包括田纳西州西部的 8 个农村和城市县、阿肯色州和密西西比州。
使用目的性和滚雪球抽样技术确定了 17 名关键信息提供者，包括社区和机构领导人员、一线工作人员和宗教领袖。
CHW 整合的关键决定因素包括在组织内部和组织之间建立明确和标准化的 CHW 角色、促进组织间网络以及为 CHW 的可维持工资和可持续职位提供资金。加强 CHW 劳动力的培训策略包括与创伤知情护理、管理压力和文化谦逊相关的内容。
几个内部和外部环境以及创新和桥梁因素影响 CHW 职位。收集的数据将为未来旨在改善艾滋病毒护理连续体结果和减少 PLWH 差异的政策和干预措施的实施和维持提供信息。
