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Concept Clearance

Strengthening the Impact of Community Health Workers on HIV Care Continuum in the US

NINR and OAR Strategic Plan Relevance:

This concept fits with NINR’s Self-management of HIV/AIDS and related co-morbidities priorities and with the following NIH OAR (Office of AIDS Research) and EHE (Ending the HIV Epidemic) research priorities: Decrease the incidence of HIV transmission and decrease and/or mange HIV-associated comorbidities, coinfections, and complications

Purpose: The purpose of this concept is to promote research on the use of community health workers (CHW) to improve care engagement leading to durable antiretroviral (ARV) medication adherence in U.S. populations with the poorest HIV treatment outcomes. The concept is intended to support research on the effectiveness and real-world translation of local and regional CHW strategies, as well as integration of mHealth and virtual reality tools to strengthen CHW’s ability to improve HIV care among people living with HIV (PLH). This program of research is geographically aimed at US counties, states and territories with the highest concentrations of HIV disease identified in the President’s plan to End the HIV Epidemic (EHE).

Rationale/Significance:

Despite the availability of highly effective HIV-targeted medicines, many of the approximately 1.2 million PLH living in the United States are not benefitting from them. The causes for lack of engagement in HIV care that leads to durable viral suppression are complex, rooted in poverty and the social stigma attached to HIV illness itself, compounded by a person’s gender, race, class, and sexual identity. Acceptance and integration of the realities of a serious health condition and developing a realistic daily management strategy takes time and support and is always vulnerable to a person’s changing circumstances. Given the limited time of clinicians, the fragmented condition of the US health care and insurance system, and the challenges inherent in the lives of poor or stigmatized groups, the development of a robust, diverse, community-savvy cadre of health workers in the US holds promise for addressing some of these ongoing challenges. As part of a provider team in the US, CHW have been successfully deployed to support people living with a variety of chronic conditions, including hypertension, diabetes, cancer and infectious illness such as TB (CDC). In the context of the US HIV epidemic, “patient navigators” have had some success in improving HIV health outcomes in research settings

In recognition of the importance of this research question, the NIH Office of AIDS Research (OAR) is supporting an NINR-led initiative on CHWs and the HIV Care Continuum. As a first step, on September 16-17, 2019, NINR led an NIH conference, funded by the NIH Office of AIDS Research (OAR) on “Strengthening the Impact of Community Health Workers on HIV Care and Viral Suppression in the U.S.” The issues and gaps identified by the attendees were used in the development of this concept.

Public Health Relevance/Impact:

Research on how community health workers and programs impact HIV care engagement, ARV adherence and other HIV health-related outcomes, and their value to improving the quality of health care to under-resourced communities, will provide guidance for bringing CHW to scale as a significant force in solving the large gaps in care engagement and between ARV prescription and viral suppression in the US. In addition, impactful CHWs strategies and programs, backed by clinical-evidence and, over time, supported through training, supervision and pay, could be an effective resource to addressing HIV comorbidities and many other clinical and public health problems in areas targeted by EHE initiative.

Research Objectives (opportunities):

  • Community-based participatory methods including thorough assessment of the policy and clinical practice context preliminary work to set the stage for scale up
  • Pragmatic trials of active (or augmented) CHW programs in EHE locations that study the impact of CHWs on HIV care and adherence health outcomes
  • Implementation research that translates CHW strategies with demonstrated efficacy in other locales and regions, to ETH locations
  • Development and testing and/or expansion of existing mHealth and Virtual approaches that strengthen work of CHWs, CHW/CBO programs or extend the geographic reach of CHW activities to support care engagement and medication adherence to EHE locations
  • Study of factors that influence how CHW draw from and impact social cohesion and program success;
  • Characterization of how, why and which specific program elements or combination of elements provide the highest impact on targeted HIV-related medication adherence and other health outcomes;

Potential Collaborators: NIDA, NIMH, NIMHD, NIDCR, OBSSR
Program Contact: Rebecca Henry, PhD, RN

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