Can lay health workers promote better medical self-management by persons living with HIV? An evaluation of the Positive Choices program

Objective: To evaluate Positive Choices (PC), a program that employed lay health workers to motivate antiretroviral adherence among persons living with HIV with coverage from Indiana's high-risk insurance pool. Methods: Four hundred and forty nine participants living in the greater Indianapolis area were randomly allocated to treatment (n=91) or control (n=358) groups and followed for one year. Results: Compared to control subjects, PC subjects were more likely to adhere to HIV medications (medication possession ratio adherence ≥0.95, OR. =1.83, p=0.046), and to achieve undetectable viral load (<50. copies/mL, OR. =2.01, p=0.011) in the 12 months following introduction of PC. There were no significant differences observed between groups in any of self-reported health status indicators. Conclusion: Estimates suggest that PC clients were 16% more likely to have undetectable viral loads than clients in standard care. The incremental program cost was approximately $10,000 for each additional person who achieved an undetectable viral load. Practice implications: As persons living with HIV experience greater longevity and healthcare reform expands coverage to these high-risk populations, greater demands will be placed on the HIV-care workforce. Results suggest lay health workers may serve as effective adjuncts to professional care providers.