5032.0 Integrating community health workers (CHWs) into health systems to improve HIV care engagement: Opportunities and challenges

Session: Ending the HIV Epidemic

Program: HIV/AIDS

Time: 9:00 -9:15 AM

Presenters:

Yue Hu

Chelsey Carter

Victor Wang

Debbie Humphries

Abstract

Background: In the Ending the HIV Epidemic initiative (EtHE), Missouri is a priority state due to high HIV incidence and low care engagement, with St. Louis accounting for nearly half of the state’s people living with HIV (PLWHs). CHWs effectively support individuals managing chronic diseases such as HIV, especially for those facing stigma, discrimination, and other barriers to services. Innovative approaches to strengthen the CHW’s role as liaisons between clinical services and community resources are needed to maximize their impact on HIV self-management.

Methods: Clinical providers (n=4), community leaders (n=5), CHWs/supervisors in HIV services (n=6), and PLWH (n=12) participated in semi-structured interviews, and front-line health workers (n=12) participated in one of two focus groups. Interview and focus group guide explored the strengths and challenges of using CHWs for enhancing management and retention in HIV care. Rapid qualitative analysis methods were used to analyze findings. Community members serving on the study’s planning team were involved in data analysis to enhance rigor and minimize bias.

Results: Participants identified institutional and systemic challenges in integrating CHWs into the healthcare system. Institutional challenges include limited CHWs’ scope of practice, unsustainable CHW workforce, and difficulties building professional relationships with other care team members. Specifically, participants identified challenges such as CHW work hours being limited to 8-5 and outreach location limited to healthcare settings, as well as silos within the care team that hinders collaboration, coordination of care, and CHW career development.

Systemic challenges identified include structural racism, a hierarchical Western European model for HIV/AIDS care, and a lack of momentum and consistency for implementation. Participants particularly highlighted stigma, historical and present racialized trauma, and the marginalization of CHWs in decision-making and care involvement.

To overcome these challenges, participants suggested clarifying CHW titles, roles, and responsibilities, improving job conditions, strengthening in-organizational support, and ensuring program sustainability. The developing intervention’s implementation strategies address the identified challenges and suggestions.

Conclusions: Strengthening effectiveness of CHW programs requires integration of CHWs into the healthcare system. A systematic, collaborative, contextually appropriate and adaptive response is necessary to scale up CHW programs, ensuring quality service delivery and long-term career viability for CHWs.