Community health promoters' role in improving health outcomes by focusing on HIV medication adherence in underserved communities in the U.S. using the Partners in Health accompagnateur model

Community health promoters (CHPs), undervalued in the U.S. health care system, play a critical role in increasing access to care in medically underserved communities of people living with HIV/AIDS. At the Prevention and Access to Care and Treatment (PACT) Project in Boston, a community- and home-based program based on Partners in Health's accompagnateur model from Haiti, CHPs focus on improving adherence to anti-retroviral therapy (ARV) medications in high-risk HIV-positive individuals who have been failing their medication regimens. We have observed improved virologic and immunologic outcomes and potential cost savings resulting from reductions in hospitalizations and opportunistic illnesses. CHPs, who are members of the communities they serve, are uniquely positioned to do this work. Presenters, including PACT CHPs, discuss how they play a central role in enhancing the health of high-risk HIV-positive members of their community, by: (1) providing responsive, contextualized, collaborative, and individualized health promotion and harm reduction services (medical accompaniment, health education, referrals, and Directly Observed Therapy); (2) assisting in the design and the implementation of operational research and developing PACT as an effective, sustainable, and replicable disease management model; (3) improving their ability to provide quality services by strengthening their own knowledge through ongoing training and receiving mental health, domestic violence, substance abuse, and medical consultations; and (4) mobilizing the community to advocate for its health and to address the underlying conditions and inequalities that create vulnerability to HIV disease. Presenters discuss the applicability and expansion of this model to other settings.