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

doi:10.1016/j.pec.2012.06.010

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

Medicine, General Medicine Division

Research output: Contribution to journal › Article › peer-review

20 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 language	English (US)
Pages (from-to)	184-190
Number of pages	7
Journal	Patient education and counseling
Volume	89
Issue number	1
DOIs	https://doi.org/10.1016/j.pec.2012.06.010
State	Published - Oct 2012

Funding

The evaluation was conducted on the PC program as it was implemented in Marion County between October 2008 and March 2010. The PC program was developed by the Indiana Comprehensive Health Insurance Association (ICHIA), the state's high-risk pool, for PLWH who were also enrolled in the Health Insurance Assistance Plan (HIAP), a program operated by the Indiana State Department of Health. HIAP provides enrollees a comprehensive major medical insurance policy that covers all premium, co-payment, and deductible costs for HIV-positive Indiana residents living at or below 300% of the federal poverty guidelines who do not qualify for Medicaid and have been unable to obtain health insurance in the private market. All HIAP enrollees are also assigned to a care manager through the Indiana State Department of Health's (ISDH) HIV Care Coordination Program. Care managers are trained professionals who locate, facilitate access to, and monitor use of the full range of HIV-related services in cooperation with the client. Care managers can also help identify government assistance programs to cover the cost of housing and other living expenses. HIAP is funded through the Ryan White Part B mechanism, and the HIV Care Coordination Program is primarily funded by state dollars. Both programs are offered at no cost to enrollees.

Keywords

HIV
Lay health workers
Medication adherence

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.pec.2012.06.010

Cite this

Roth, A. M., Holmes, A. M., Stump, T. E., Aalsma, M. C., Ackermann, R. T., Carney, T. S., Katz, B. P., Kesterson, J., Erdman, S. M., Balt, C. A., & Inui, T. S. (2012). Can lay health workers promote better medical self-management by persons living with HIV? An evaluation of the Positive Choices program. Patient education and counseling, 89(1), 184-190. https://doi.org/10.1016/j.pec.2012.06.010

@article{a3addbacd48c413daf8f0a60e8884f09,

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

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.",

keywords = "HIV, Lay health workers, Medication adherence",

author = "Roth, \{Alexis M.\} and Holmes, \{Ann M.\} and Stump, \{Timothy E.\} and Aalsma, \{Matthew C.\} and Ackermann, \{Ronald T.\} and Carney, \{Theodore S.\} and Katz, \{Barry P.\} and Joseph Kesterson and Erdman, \{Sharon M.\} and Balt, \{Christine A.\} and Inui, \{Thomas S.\}",

note = "Funding Information: The evaluation was conducted on the PC program as it was implemented in Marion County between October 2008 and March 2010. The PC program was developed by the Indiana Comprehensive Health Insurance Association (ICHIA), the state's high-risk pool, for PLWH who were also enrolled in the Health Insurance Assistance Plan (HIAP), a program operated by the Indiana State Department of Health. HIAP provides enrollees a comprehensive major medical insurance policy that covers all premium, co-payment, and deductible costs for HIV-positive Indiana residents living at or below 300\% of the federal poverty guidelines who do not qualify for Medicaid and have been unable to obtain health insurance in the private market. All HIAP enrollees are also assigned to a care manager through the Indiana State Department of Health's (ISDH) HIV Care Coordination Program. Care managers are trained professionals who locate, facilitate access to, and monitor use of the full range of HIV-related services in cooperation with the client. Care managers can also help identify government assistance programs to cover the cost of housing and other living expenses. HIAP is funded through the Ryan White Part B mechanism, and the HIV Care Coordination Program is primarily funded by state dollars. Both programs are offered at no cost to enrollees. ",

year = "2012",

month = oct,

doi = "10.1016/j.pec.2012.06.010",

language = "English (US)",

volume = "89",

pages = "184--190",

journal = "Patient education and counseling",

issn = "0738-3991",

publisher = "Elsevier Ireland Ltd",

number = "1",

}

Roth, AM, Holmes, AM, Stump, TE, Aalsma, MC, Ackermann, RT, Carney, TS, Katz, BP, Kesterson, J, Erdman, SM, Balt, CA & Inui, TS 2012, 'Can lay health workers promote better medical self-management by persons living with HIV? An evaluation of the Positive Choices program', Patient education and counseling, vol. 89, no. 1, pp. 184-190. https://doi.org/10.1016/j.pec.2012.06.010

TY - JOUR

T1 - Can lay health workers promote better medical self-management by persons living with HIV? An evaluation of the Positive Choices program

AU - Roth, Alexis M.

AU - Holmes, Ann M.

AU - Stump, Timothy E.

AU - Aalsma, Matthew C.

AU - Ackermann, Ronald T.

AU - Carney, Theodore S.

AU - Katz, Barry P.

AU - Kesterson, Joseph

AU - Erdman, Sharon M.

AU - Balt, Christine A.

AU - Inui, Thomas S.

N1 - Funding Information: The evaluation was conducted on the PC program as it was implemented in Marion County between October 2008 and March 2010. The PC program was developed by the Indiana Comprehensive Health Insurance Association (ICHIA), the state's high-risk pool, for PLWH who were also enrolled in the Health Insurance Assistance Plan (HIAP), a program operated by the Indiana State Department of Health. HIAP provides enrollees a comprehensive major medical insurance policy that covers all premium, co-payment, and deductible costs for HIV-positive Indiana residents living at or below 300% of the federal poverty guidelines who do not qualify for Medicaid and have been unable to obtain health insurance in the private market. All HIAP enrollees are also assigned to a care manager through the Indiana State Department of Health's (ISDH) HIV Care Coordination Program. Care managers are trained professionals who locate, facilitate access to, and monitor use of the full range of HIV-related services in cooperation with the client. Care managers can also help identify government assistance programs to cover the cost of housing and other living expenses. HIAP is funded through the Ryan White Part B mechanism, and the HIV Care Coordination Program is primarily funded by state dollars. Both programs are offered at no cost to enrollees.

PY - 2012/10

Y1 - 2012/10

N2 - 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.

AB - 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.

KW - HIV

KW - Lay health workers

KW - Medication adherence

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

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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