Piloting a Peer-Driven Intervention Model to Increase Access and Adherence to Antiretroviral Therapy and HIV Care among Street-Entrenched HIV-Positive Women in Vancouver

Abstract

A peer-driven intervention (PDI) was developed to support uptake and adherence to highly active antiretroviral therapy (HAART) among women sex workers who use illicit substances in Vancouver, because uptake and adherence continues to be suboptimal. Trends of adherence were examined among women in this program by (1) exposure to the intervention and (2) risk behaviors including drug use and unstable housing. Between January 2007 and January 2008, 20 HIV-positive women were enrolled into the PDI on a rolling basis. PDI participation included weekly peer support meetings, a health advocate (buddy) system, peer outreach service, and onsite nursing care. Adherence was measured directly with pharmacy records (PR) and indirectly with self-report and viral load (VL) outcomes. Participants attended an average of 50 (21-70) PDI meetings. Overall self-reported adherence was high (92%) and most women (11) reported increased adherence from the first to the last 13 PDI meetings attended (average increase = 18%). The number of viral load tests <or=50 copies/mL increased by 40% from the pre-PDI period (1 year before enrollment), to the PDI period (duration enrolled). PR adherence and improvements in VL outcomes were higher among participants with greater housing instability and frequency of injecting/smoking drugs. Despite a very difficult environment to provide HIV care, there is evidence to suggest that the PDI may have had a positive impact on adherence outcomes. Although this would not predict long-term treatment success, the PDI approach to HIV treatment support is a promising program for women who might otherwise be excluded from treatment altogether.

Can community health workers improve adherence to highly active antiretroviral therapy in the USA? A review of the literature

“…This highlights the need for future multisite studies with consistent methodologies to determine how geographical and population differences influence outcomes. Deering et al [20] To determine if a peer intervention will increase access and adherence to HAART Study located outside of the USA Rueda et al [23] To conduct a systematic review of the literature on the effectiveness of patient support and education to improve HAART adherence Not all studies used community health workers, and not all studies were located in the USA Simoni et al [21] To summarize the literature on behavioural interventions to promote HAART adherence Studies were not all located in the USA Altice et al [26] To assess adherence outcomes in directly observed HAART compared with standard of care No biological outcomes Shelton et al [45] To determine if HIV case managers improve adherence to HAART No biological outcomes Amico et al [46] To conduct a quantitative review of published trials on HAART adherence interventions Not all studies used community health workers; not all studies reported biological outcomes Ivers et al [22] To summarize the literature on HAART programmes in resource-poor settings Studies were not all located in the USA Wohl et al [47] To determine if treatment support programmes improve adherence to HAART No biological outcomes Altice et al [48] To develop a directly observed HAART programme for HIV-infected drug users The intervention used a community outreach van but did not specifically utilize community health workers Broadhead et al [49] To determine if injecting drug users can carry out the work of professional outreach workers effectively…”

“…Several articles have described how the CHW model is currently and successfully implemented outside the USA to improve HAART adherence in disadvantaged areas, yet few have focused on the CHW model in the USA [13,14,[20][21][22][23]. To enhance our understanding of the utility of CHWs in improving HAART adherence in the USA, we reviewed programmes that relied on this approach to improve biological HIV outcomes.…”

Linking peers, patients, and providers: A qualitative study of a peer integration program for hard-to-reach patients living with HIV/AIDS

“…To date, there is a dearth of research on the peer integration model. However, some studies have pointed to the efficacy of incorporating peers as health advocates in clinical settings to improve patient screening, access to care, and health outcomes (Deering et al, 2009;Norman et al, 2008). For instance, one study of a PDI that trained peers as health advocates for HIV-positive women found that women reported increased adherence across the course of all peer-driven meetings.…”

A Pilot Study Of CPAP Adherence Promotion By Peer Buddies With Sleep Apnea

“…Promoting adherence to therapy through peer-driven intervention is cost-effective and has met with modest success in other chronic conditions such as HIV, heart failure, and diabetes mellitus. [2][3][4] Whether such a peer-driven ("buddy") system can improve adherence to CPAP therapy is unknown.…”