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

Alexis M. Roth*, Ann M. Holmes, Timothy E. Stump, Matthew C. Aalsma, Ronald T. Ackermann, Theodore S. Carney, Barry P. Katz, Joseph Kesterson, Sharon M. Erdman, Christine A. Balt, Thomas S. Inui

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)184-190
Number of pages7
JournalPatient education and counseling
Volume89
Issue number1
DOIs
StatePublished - Oct 2012

Keywords

  • HIV
  • Lay health workers
  • Medication adherence

ASJC Scopus subject areas

  • Medicine(all)

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