A Community Health Worker Approach for Ending the HIV Epidemic

Abstract

Introduction:In the second half of 2019, East Baton Rouge Parish, Louisiana was selected as 1 of the 3 jump-start pilot jurisdictions for the Centers for Disease Control and Prevention−funded Ending the HIV Epidemic in the U.S. Initiative. An innovative community health worker program was among the strategies developed to reduce the number of new HIV infections. In addition to testing for HIV/sexually transmitted infections in nontraditional settings, community health workers provided integrated services, including linkage for people with HIV, pre-exposure prophylaxis navigation, sterile injection supplies and referrals to syringe services programs, and other social services. Methods:The 5-member community health worker team was representative of the populations they intended to reach. They conducted outreach, from October 2019 to December 2020, within areas known to have a high incidence of new HIV infections. Results:The community health worker team documented 977 encounters with individuals in their communities. The vast majority of encounters were among Black clients; 9% were among White clients. In total, 48% were among cisgender women, 50% were among cisgender men, and 2% were among transgender women. People who inject drugs represented 7% of the sample. Community health workers conducted rapid testing for HIV (n=320), hepatitis C (n=274), and syphilis (n=280). In addition, they successfully linked 10 people with HIV to HIV medical care and 20 people who inject drugs to a syringe services program and assisted 19 people at risk of HIV infection with preexposure prophylaxis initiation. Conclusions:The community health worker team successfully facilitated access to HIV prevention and treatment for priority populations in East Baton Rouge Parish.

HIV Testing Strategies for Health Departments to End the Epidemic in the U.S.

“…CDC has also developed and piloted interventions such as the social network strategy for recruiting peers who would benefit from HIV testing 70 , 71 and has developed trainings for community-based organizations to implement this strategy. 72 A specific, innovative use of a cohort of peer community health workers to conduct outreach and testing in community settings that was implemented as part of the EHE jump-start in East Baton Rouge Parrish, Louisiana 14 is included in this issue. There are a wide variety of adaptations of these methods, and therefore, there is a need for more implementation science 73 to identify the best new strategies to increase testing in outreach settings.…”

“…Other models, 57 such as the combined offer of HIV and COVID-19 testing at drive-through test sites, and online counselor-led HIV self-testing have shown promise. Hammack et al 14 describe how they adapted their novel outreach model during the pandemic, including information about options for COVID-19 testing, in a way that makes the entire encounter with the community health workers less about HIV and more about health, a strategy that may reduce the stigma associated with HIV testing. Leveraging the lessons learned from the COVID-19 pandemic to improve access to and uptake of HIV testing is an opportunity.…”

“…Likewise, a positive test result must be followed by linkage to HIV care and initiation of antiretroviral therapy, leading to viral suppression. For people with HIV who are not engaged in care, community testing strategies such as those implemented in East Baton Rouge Parish, Louisiana and described in this issue 14 represent an opportunity to offer HIV care re-engagement to achieve viral suppression. The integrated approach also includes the role HIV care providers have in offering HIV tests, PrEP, and other prevention services to their patient’s sex or drug-using partners.…”

Interventions Designed to Improve HIV Continuum of Care Outcomes for Persons with HIV in Contact with the Carceral System in the USA

“…In one large urban HIV clinic, the period following these restrictions was associated with a 33% reduction in VS compared to the period before then; Black/African American race, homelessness, and age < 35 were associated with worse VS reductions [ 94 ]. Seismic shifts in HIV care delivery (e.g., telephone visits, home delivery of medications, administrative changes to minimize insurance gaps) and social service provision (e.g., improved access to housing, proactive outreach models using community health workers) have been implemented that may exacerbate, mitigate, or create new challenges to care access [ 94 – 96 ]. Additional intervention research is needed to understand and address the impact of these shifts on HIV outcomes among PWH with carceral system involvement.…”

Trends in U.S. HIV Peer Health Worker Training Strategies and Approaches: A Scoping Review of the Literature

“…Shared characteristic(s), such as race/ethnicity, sexual orientation, and gender, further facilitates an open and trusting relationship between the peer and client (i.e., participant; Enriquez et al, 2013), particularly among marginalized populations (Houston et al, 2015). Given the detrimental influence of social determinants of health (e.g., racism and discrimination, stigma, and limited access to social support) on adherence behavior and retention in care for PWH (CDC, 2022d), peers are uniquely positioned to serve in a professional role to improve the health and wellness of PWH (Hammack et al, 2021; Rencken et al, 2021).…”