5th Annual Conference, Society for Social Work and Research,
Atlanta, GA. January 2001
Colson P, Hirsch Y, El-Sadr W,
Thomas G, Nader N, Gee V. The role of peer workers
in supporting medication adherence in Harlem.
Peer workers (PWs) have been used in different health settings
to improve adherence to various regimens, including HIV, hypertension,
and breast cancer screening. However, details of their functions
and tasks have not been well described.
Methods: In a randomized
clinical trial, patients (pts) undergoing treatment for latent
tuberculosis infection (LTBI) were assigned to a peer worker
(PW) or self-administered treatment. PWs are members of the
same community, who have successfully completed TB treatment.
We evaluated the functions and tasks performed by PWs, using
information on encounters documented in a contact form. PWs
also complete an assessment of each pt who finishes treatment.
Data on 57 pts who were assigned a PW and have completed LTBI
treatment were analyzed.
The length of LTBI treatment varied from 6-12 months with
an average of 13 encounters per pt. Encounters most often
occurred in the clinic (36%), 17% were in PWs' office, and
15% in pts' homes. Actions included counseling (82%) (including
adherence, personal matters, medical issues, medications),
navigation (8%), checking-up on pts (8%), and referrals (4%).
As per PW assessments, 14% of pts adhered every day with LTBI,
81% most days, and 5% were non-adherent. Reasons for non-adherence
included having too many other problems (50%), not understanding
regimen (21%), side effects (17%), not thinking they were
sick (15%), and homelessness (10%). PWs thought that 63% of
pts benefited from their relationship, that 25% did not need
a PW, that they were unable to communicate with 11%, and that
2% of pts became too dependent.
Implications for Practice:
The use of PWs who themselves completed TB treatment may provide
a feasible and cost-effective model for helping pts adhere
to LTBI treatment. The development of such models is particularly
important in under-served communities with poor health outcomes.