Abstract
Background: Community Health Workers (CHWs) have long been integrated in the delivery of HIV care, in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes.There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. Methods: Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n=20). Findings: Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and TA strategies. Conclusions: Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for health care organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW implementation. The integration of the CHW role may present an occasion for health care delivery organizations to reassess policies that may unintentionally marginalize communities and both limit career opportunities and patient engagement.
Service Delivery and Patient Outcomes in Ryan White HIV/AIDS Program–Funded and –Nonfunded Health Care Facilities in the United States
