Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States.
Clinical and Translational Science Institute, University of Miami Miller School of Medicine, Miami, FL, United States.
JMIR Form Res. 2024 Oct 4;8:e56411. doi: 10.2196/56411.
Research has shown that integrating community health workers (CHWs) into the formal health care system can improve outcomes for people living with HIV, yet there is limited literature exploring this framework among marginalized minority populations.
Herein, we discuss the feasibility of a clinic-embedded CHW strategy to improve antiretroviral therapy adherence among Black people living with HIV in Miami-Dade County, Florida, a designated priority region for the US Department of Health and Human Services' Ending the HIV Epidemic Initiative.
From December 2022 to September 2023, three CHWs were trained and integrated into the hospital workflow to provide support as members of the clinical team. Ten Black adults with an HIV viral load over 200 copies/mL were enrolled to received 3 months of CHW support focused on navigating the health system and addressing poor social determinants of health. Intervention feasibility was based on 4 criteria: recruitment rate, demographic composition, study fidelity, and qualitative feedback on CHW perceptions.
Participants were recruited at a rate of 5.7 participants per month, with the sample evenly distributed between men and women. Retention was moderately strong, with 7 (70%) of the 10 participants attending more than 75% of CHW sessions. Qualitative feedback reflected CHW perceptions on clinical interactions and intervention length.
Outcomes indicate that a clinic-integrated CHW approach is a feasible and acceptable methodology to address adverse social determinants and improve HIV treatment adherence. By offering targeted social and clinical support, CHWs may be a promising solution to achieve sustained viral suppression and care engagement for Black people living with HIV.
研究表明，将社区卫生工作者（CHWs）纳入正规医疗保健系统可以改善艾滋病毒感染者的治疗效果，但关于边缘化少数群体中这种模式的文献有限。
在此，我们讨论了在佛罗里达州迈阿密-戴德县实施诊所嵌入 CHW 策略的可行性，该县是美国卫生与公众服务部终结艾滋病毒流行倡议指定的重点优先区域。
从 2022 年 12 月至 2023 年 9 月，培训了 3 名 CHW 并将其纳入医院工作流程，作为临床团队的成员提供支持。纳入了 10 名 HIV 病毒载量超过 200 拷贝/ml 的黑人成年人，接受为期 3 个月的 CHW 支持，重点是帮助他们了解卫生系统并解决不良的社会决定因素对健康的影响。干预的可行性基于 4 个标准：招募率、人口统计学构成、研究保真度和对 CHW 看法的定性反馈。
参与者的招募率为每月 5.7 人，样本在男女之间平均分布。保留率适中，10 名参与者中有 7 人（70%）参加了超过 75%的 CHW 会议。定性反馈反映了 CHW 对临床互动和干预时长的看法。
结果表明，诊所整合 CHW 方法是解决不良社会决定因素和提高艾滋病毒治疗依从性的可行且可接受的方法。通过提供有针对性的社会和临床支持，CHW 可能是实现黑人艾滋病毒感染者持续病毒抑制和护理参与的有前途的解决方案。
