Community Health Workers, Clinic Doctors Collaborate to Tackle HIV Disparities

The public health researcher affectionately called “The HIV Lady” in Miami’s hardest-hit neighborhoods has received a $2 million grant to expand her work, mobilizing community health workers (CHWs) to assist Black patients living with HIV/AIDS.

The National Institutes of Health gave a prestigious R01 grant to pioneering Sonjia Kenya, Ed.D., M.S., M.A., associate professor of general medicine and public health at the University of Miami Miller School of Medicine. Dr. Kenya is also associate director of the Behavioral Science Core at the Miami Center for AIDS Research (CFAR), among other roles.

“I’m beyond thrilled to receive such a high level of NIH support focused on improving HIV outcomes in Black people. These grants are highly competitive and less than 2% have been awarded to Black scientists,” Dr. Kenya said. Her projects focus on low-income Black communities in Miami, which have some of the highest rates of HIV nationwide.

The grant finances a new program called INSTACARE (Integrated Navigation Services for Treatment, Adherence, Counseling, and Research). The program embeds CHWs into the clinical care system for select HIV cases, “so they can be at patient appointments in the clinic, at case conferences and meetings with social workers, doctors and other providers, and still perform support services in the community,” Dr. Kenya said. As clinicians and CHWs learn from each other and collaborate, health outcomes for HIV patients should improve, she said.

“We are in a position to have this become the standard of care throughout the country,” said Dr. Kenya.

Building on Previous Successes

The new grant builds on Dr. Kenya’s work that began in 2011, mobilizing residents of Miami’s Black areas to assist their neighbors in culturally familiar ways. First, she trained CHWs to help Black people living with HIV take their medications. Next, her team received a modest $60,000 grant to see whether CHWs could facilitate HIV screening for their neighbors in community settings outside of the clinics. That success grew into what is now Miami-Dade County’s largest street-based HIV screening program, Dr. Kenya said.

More recently, the CHWs extended outreach to actual health care, helping residents of Black neighborhoods gain access to meds that can stop the spread of HIV before or after sex or other exposure, she said. Still, Dr. Kenya saw lots more potential.

“One of our biggest barriers has been when CHWs go with a patient into a clinic. Sometimes, providers don’t know what to make of them. They’ll ask, ‘Who are you? Are you a cousin? Are you an advocate?’ because CHWs are not really part of the formal health care system,” Dr. Kenya said.

The five-year INSTACARE program embeds CHWs into HIV clinics to improve medication adherence and care continuity among 300 Black patients living with HIV. Participant outcomes will be compared with others in the same communities who lack CHW support. The patients come from Miami’s most vulnerable Black communities, including Liberty City and Overtown, where many residents have low incomes, little formal education and, among immigrants, limited English skills. Many residents are wary of formal health care systems and have greater trust for neighbors who know their culture, Dr. Kenya said.

Integrating Community Health Workers

The program will operate at the University of Miami/Jackson Memorial HIV Outpatient Clinic, which now serves more than 3,000 people living with HIV, mostly Black and Hispanic, said Allan E. Rodriguez, M.D., professor of clinical medicine in the Division of Infectious Diseases, who leads the clinic and is director of the Behavioral/Social Science and Community Outreach Core of the Miami CFAR.

“The CHWs will interface with the social worker on each case and be integrated into social worker access to medical information they need,” said Dr. Rodriguez. For instance, CHWs might get numbers on HIV viral loads to check whether a patient is taking their meds. “Now, CHWs work independently and don’t necessarily know what is going on clinically. So, this is an integration.”

Rodriguez says that INSTACARE is important because it targets factors that contribute to disparities in HIV rates and health progress in Miami’s most vulnerable neighborhoods.

“Having people from the community to help the patient navigate and access resources and to encourage them to communicate better with the clinician should lead to better outcomes,” says Dr. Rodriguez. “It also could be a model of enhancing health care by extending what is done in the clinic to the home. The idea is for patients who are not doing well to get the CHW to go to the house and help them navigate the system. That could definitely lead to better outcomes.”

Tags: CFAR, Department of Public Health Sciences, Division of Infectious Diseases, Dr. Sonjia Kenya, HIV/AIDS, INSTACARE, Miami Center for AIDS Research, Miller School of Medicine, NIH funding, University of Miami/Jackson Memorial Medical Center