Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Sheela Shenoi

Second Advisor

Gerald Friedland

Abstract

Introduction: With the ongoing global HIV/AIDS burden, community-based service delivery models are increasingly recognized, with community health workers (CHWs) at the forefront. In high-income countries (HICs) like the United States, CHWs have long served marginalized communities, gaining recent legislative attention. Despite this, there's still a need for comprehensive evidence on CHW integration in healthcare delivery.

Methodology: We conducted a scoping review to gather available evidence on community health workers (CHWs) and their impact on HIV outcomes in HICs, and to identify evidence gaps in the use of community-based HIV/PrEP services in HICs. Using the American Public Health Association’s definition of a “community health worker” and following PRISMA guidelines, we searched peer-reviewed literature published through February 2024.

Results: Of 1631 abstracts screened, 34 articles were selected. Approximately half of the studies (n=19) focused solely on interventions directly related to HIV care and outcomes. The remaining studies integrated HIV care interventions with STIs (n=8), hepatitis (n=5), substance abuse (n=5), LGBTQ+ health (n=1), and general women’s health (n=1). Furthermore, technology played a significant role in 4 studies. The roles and responsibilities of CHWs encompassed cultural mediation, health education, care coordination, social and emotional support, advocacy, capacity building, direct service provision, outreach, and participation in research efforts. The majority of studies concerned Black and Latino populations (n=19). Quantitative findings across the HIV care continuum encompassed various aspects: HIV testing/diagnosis (n=22), ART initiation (n=2), adherence (n=6), and retention (n=2), as well as viral suppression (n=8), and PrEP initiation (n=3), adherence (n=1), and retention (n=1).

Conclusions: Overall, CHWs' interventions employ diverse strategies, including community-based, culturally tailored, and technology-driven approaches, to enhance HIV care outcomes. Leveraging CHWs enables policymakers and practitioners to bridge healthcare gaps and tackle disparities, ultimately fostering health equity and enhancing overall health outcomes in HICs.

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This is an Open Access Thesis.

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