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.

Purpose: 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.

Results: 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.