Delivering comprehensive HIV services across the HIV care continuum: a comparative analysis of survival and progress towards 90-90-90 in rural Malawi

IntroductionPartners In Health and the Malawi Ministry of Health collaborate on comprehensive HIV services in Neno, Malawi, featuring community health workers, interventions addressing social determinants of health and health systems strengthening. We conducted an observational study to describe the HIV care continuum in Neno and to compare facility-level HIV outcomes against health facilities nationally.MethodsWe compared facility-level outcomes in Neno (n=13) with all other districts (n=682) from 2013 to 2015 using mixed-effects linear regression modelling. We selected four outcomes that are practically useful and roughly mapped on to the 90-90-90 targets: facility-based HIV screenings relative to population, new antiretroviral therapy (ART)enrolments relative to population, 1-year survival rates and per cent retained in care at 1 year.ResultsIn 2013, the average number of HIV tests performed, as a per cent of the adult population, was 11.75%, while the average newly enrolled patients was 10.03%. Percent receiving testing increased by 4.23% over 3 years (P<0.001, 95% CI 2.98% to 5.49%), while percent enrolled did not change (P=0.28). These results did not differ between Neno and other districts (P=0.52), despite Neno having a higher proportion of expected patients enrolled. In 2013, the average ART 1-year survival was 80.41% nationally and 91.51% in Neno, which is 11.10% higher (P=0.002, 95% CI 4.13% to 18.07%). One-year survival declined by 1.75% from 2013 to 2015 (P<0.001, 95% CI −2.61% to −0.89%); this was similar in Neno (P=0.83). Facility-level 1-year retention was 85.43% nationally in 2013 (P<0.001, 95% CI 84.2% to 86.62%) and 12.07% higher at 97.50% in Neno (P=0.001, 95% CI 5.08% to19.05%). Retention declined by 2.92% (P<0.001, 95% CI −3.69% to −2.14%) between 2013 and 2015, both nationally and in Neno.ConclusionThe Neno HIV programme demonstrated significantly higher survival and retention rates compared with all other districts in Malawi. Incorporating community health workers, strengthening health systems and addressing social determinants of health within the HIV programme may help Malawi and other countries accelerate progress towards 90-90-90.

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Integrating community health workers into a community hearing health collaborative to understand the social determinants of health in children with hearing loss

Disability and Health Journal ◽

10.1016/j.dhjo.2021.101181 ◽

2021 ◽

pp. 101181

Author(s):

Luz Adriana Matiz ◽

Stephen Leong ◽

Patricia J. Peretz ◽

Megan Kuhlmey ◽

Stacey A. Bernstein ◽

...

Keyword(s):

Hearing Loss ◽

Community Health ◽

Social Determinants Of Health ◽

Community Health Workers ◽

Social Determinants ◽

Health Workers ◽

Determinants Of Health ◽

The Social ◽

Hearing Health ◽

Children With Hearing Loss

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Social Determinants of Health as Potential Influencers of a Collaborative Care Intervention for Patients with Hypertension

Ethnicity & Disease ◽

10.18865/ed.31.1.47 ◽

2021 ◽

Vol 31 (1) ◽

pp. 47-56

Author(s):

Chidinma A. Ibe ◽

Carmen Alvarez ◽

Kathryn A. Carson ◽

Jill A. Marsteller ◽

Deidra C. Crews ◽

...

Keyword(s):

Health Literacy ◽

Community Health ◽

Social Determinants Of Health ◽

Community Health Workers ◽

Social Determinants ◽

Collaborative Care ◽

Health Workers ◽

Determinants Of Health ◽

Nurse Care ◽

Care Intervention

Objectives: The use of collaborative care teams, comprising nurse care managers and community health workers, has emerged as a promising strategy to tackle hypertension disparities by addressing patients’ social determinants of health. We sought to identify which social determinants of health are associated with a patient’s likelihood of engaging with collaborative care team members and with the nurse care manager’s likelihood of enlisting community health workers (CHW) to provide additional support to patients.Methods: We conducted a within-group longitudinal analysis of patients assigned to receive a collaborative care intervention in a pragmatic, cluster randomized trial that aims to reduce disparities in hypertension control (N=888). Generalized estimating equations were used to identify which social determinants of health, reported on the study’s baseline survey, were associated with the odds of patients engaging with the collaborative care intervention, and of nurses deploying community health workers.Results: Patients who were unable to work and those with higher health literacy were less likely to engage with the collaborative care team than those who were employed full time or had lower health literacy, respectively. Patients had a greater likelihood of being referred to a community health worker by their care manager if they reported higher health literacy, perceived stress, or food insecurity, while those reporting higher numeracy had lower odds of receiving a CHW referral.Implications/Conclusions: A patient’s social determinants of health influence the extent of engagement in a collaborative care intervention and nurse care manager appraisals of the need for supplementary support provided by community health workers.Ethn Dis. 2021;31(1):47-56; doi:10.18865/ed.31.1.47

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A mixed methods evaluation of the feasibility, acceptability, and impact of a pilot project ECHO for community health workers (CHWs)

Pilot and Feasibility Studies ◽

10.1186/s40814-020-00678-y ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

April Joy Damian ◽

Sarafina Robinson ◽

Faaiza Manzoor ◽

Mandy Lamb ◽

Adriana Rojas ◽

...

Keyword(s):

Mixed Methods ◽

Community Health ◽

Social Determinants Of Health ◽

Community Health Workers ◽

Social Determinants ◽

Self Efficacy ◽

Social Issues ◽

Health Workers ◽

Determinants Of Health ◽

Project Echo

Abstract Background Despite the positive effects of community health workers (CHWs) on addressing social determinants of health, improving patient health outcomes, and decreasing overall healthcare costs, there is a lack of standardization in training and certifying this workforce, resulting in different approaches to integrating this role into medical home models. The purpose of the current study is to evaluate the application of Project ECHO (Extension for Community Healthcare Outcomes) in enhancing CHWs’ capacity to address health and social issues of vulnerable populations. Methods An explanatory sequential mixed methods design was applied in which all participants (N = 49) completed pre (January 2019) and post (July 2019) quantitative online surveys measuring changes in self-efficacy, behavior change intent, and knowledge. Virtual focus groups were conducted with a subset of participants (n = 20) in July 2019 to assess the feasibility, acceptability, and impact of Project ECHO. Results There was a statistically significant difference of + 0.453 in the composite self-efficacy mean score pre- to post-series. For every 1 additional Project ECHO CHW session attended, there was a .05 improvement in participants’ self-efficacy to perform CHW-related job duties and address social determinants of health (SDOH). Four major themes emerged from the qualitative focus group data: value in learning from other participants’ caseloads, CHW-care team integration, availability of training and resources, and shared decision-making with patients. Conclusions This evaluation suggests that ECHO is a viable means of increasing access to training resources for CHWs. Future studies on the ECHO model as a means of educating and broadening implementation of CHWs are warranted. Programs such as Project ECHO can support CHWs by providing continuing education opportunities, as well as standardizing training content across large geographic areas.

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Community Health Workers and Covid-19 — Addressing Social Determinants of Health in Times of Crisis and Beyond

New England Journal of Medicine ◽

10.1056/nejmp2022641 ◽

2020 ◽

Vol 383 (19) ◽

pp. e108 ◽

Cited By ~ 3

Author(s):

Patricia J. Peretz ◽

Nadia Islam ◽

Luz Adriana Matiz

Keyword(s):

Community Health ◽

Social Determinants Of Health ◽

Community Health Workers ◽

Social Determinants ◽

Health Workers ◽

Determinants Of Health

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Can Community Health Workers Increase Palliative Care Use for African American Patients? A Pilot Study

JCO Oncology Practice ◽

10.1200/op.20.00574 ◽

2021 ◽

Vol 17 (2) ◽

pp. e158-e167

Author(s):

Ramy Sedhom ◽

Richard Nudotor ◽

Karen M. Freund ◽

Thomas J. Smith ◽

Lisa A. Cooper ◽

...

Keyword(s):

Palliative Care ◽

African American ◽

Community Health ◽

Social Determinants Of Health ◽

Community Health Workers ◽

Social Determinants ◽

Health Workers ◽

Symptom Assessment ◽

Determinants Of Health ◽

Study Patient

PURPOSE: African American patients with cancer underutilize advance care planning (ACP) and palliative care (PC). This feasibility study investigated whether community health workers (CHWs) could improve ACP and PC utilization for African American patients with advanced cancer. METHODS: African American patients diagnosed with an advanced solid organ cancer (stage IV or stage III disease with a palliative performance score < 60%) were enrolled. Patients completed baseline surveys that assessed symptom burden and distress at baseline and 3 months post-CHW intervention. The CHW intervention consisted of a comprehensive assessment of multiple PC domains and social determinants of health. CHWs provided tailored support and education on the basis of iterative assessment of patient needs. Intervention feasibility was determined by patient and caregiver retention rate above 50% at 3 months. RESULTS: Over a 12-month period, 24 patients were screened, of which 21 were deemed eligible. Twelve patients participated in the study. Patient retention was high at 3 months (75%) and 6 months (66%). Following the CHW intervention, symptom assessment as measured by Edmonton Symptom Assessment System improved from 33.8 at baseline to 18.8 ( P = .03). Psychological distress improved from 5.5 to 4.7 ( P = .36), and depressive symptoms from 42.2 to 33.6 ( P = .09), although this was not significant. ACP documentation improved from 25% at baseline to 75% at study completion. Sixty-seven percentage of patients were referred to PC, with 100% of three decedents using hospice. CONCLUSION: Utilization of CHWs to address PC domains and social determinants of health is feasible. Although study enrollment was identified as a potential barrier, most recruited patients were retained on study.

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Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis

AIDS and Behavior ◽

10.1007/s10461-021-03551-y ◽

2021 ◽

Author(s):

Vasiliki Papageorgiou ◽

Bethan Davies ◽

Emily Cooper ◽

Ariana Singer ◽

Helen Ward

Keyword(s):

Systematic Review ◽

Social Determinants ◽

Meta Analysis ◽

Hiv Treatment ◽

Material Deprivation ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Living With Hiv

AbstractDespite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.

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