Health Literacy, Health Outcomes and Community Health Worker Utilization in HIV Primary Care

Abstract

Background: People with HIV (PWH) have complex needs, and those with limited health literacy consistently have poorer HIV-related knowledge and health outcomes. One strategy to facilitate better outcomes for PWH is the inclusion of community health workers (CHWs) in care teams. This study examines the effect of health literacy on clinical outcomes and utilization of CHW services among PWH enrolled in a CHW intervention. The secondary aim is to characterize most common purposes of CHW encounters. Methods: Individuals (n=209) enrolled in a CHW intervention with completed 6-month follow-up evaluation visits were included. Health literacy level was measured at baseline with the BRIEF tool and categorized into inadequate, marginal, and adequate health literacy. Adjusted logistic regressions assessed the effect of health literacy on viral load suppression, HIV primary care visits at 6-month follow-up, CHW utilization and purpose of CHW encounter. Purpose of CHW encounters included logistical support, accompany to appointment, transportation coordination, concrete services, coaching, and emotional support. Linear regression assessed the association between purpose of CHW encounters and CHW utilization. Results: Individuals with inadequate health literacy were more likely to receive coaching from CHWs, and individuals with marginal health literacy were more likely to have an HIV primary care visit at 6 months. Individuals receiving transportation coordination, concrete services, coaching, and emotional support had more total CHW encounters. Conclusions: PWH often receive coaching from CHWs, particularly those with lower health literacy. The purpose of CHW encounter was associated with frequency of CHW encounters, indicating these types of services require more assistance from CHWs.