Peers increase adherence among HIV patients at Kansas City Free Health Clinic
Kansas City Free Health Clinic, providing basic health care services at no charge to people who cannot pay for care, has delivered services for HIV-infected individuals since the early 1980s. The clinic began its first peer program in 2000, as the advent of potentially life-extending antiretroviral drug therapy made it imperative that patients adhere to a rigorous, long-term treatment plan. The goal of the program is to engage newly infected people in medical care and increase the treatment adherence rate among HIV patients.
Designed initially as an education program to provide information to the community at large, the program gradually evolved to focus attention on small groups and one-on-one interventions with patients. Today, a team of four peer educators— members of the community living with HIV who are specially trained to support others living with HIV— provides a range of services to patients at the Kansas City Free Health Clinic.
The peer educator is a paid paraprofessional position within the clinic. Peers work a total of 25 hours per month in shifts that are scheduled so that a peer is always available when the clinic is open.
Equal members of the interdisciplinary team
One hurdle the fledgling program had to overcome was skepticism on the part of providers about the role of peers in one-on-one situations with patients. Close supervision and a goal-oriented approach to patient interactions helped to allay concerns. “Some of those concerns were mine,” admitted Sally Neville, director of HIV Primary Care at the clinic. “We made a decision early on that we needed a highly skilled person in a supervisory role, someone who is respected by the other professionals in the clinic. By providing weekly one-on-one meetings with the supervisor, reinforced by close supervision in the clinic, those fears were readily overcome.”
“By now we have integrated our peers completely into our team of care providers,” said Neville. “They participate in weekly team meetings and chart in the patients’ medical records. From a policy and procedure viewpoint, our peers have developed into equal members of the interdisciplinary team.”
Training to help others help themselves
Since 2005, peer training for Kansas City Free Health Clinic has been provided through the People to People program, a collaboration of the Missouri AIDS Alliance which includes the clinic, the American Red Cross St. Louis Area Chapter, and the Midwest AIDS Training and Education Center of Missouri (MATEC MO). Using the Red Cross’s vast experience in health care training, MATEC MO’s expertise in curriculum development, and the hands-on experience of the peer program at the Kansas City Free Clinic, the alliance developed and piloted a curriculum based on research of best practices for peer programs nationwide, adult learning theory guidelines, and the needs of the local community.
The resulting four-day training covers the basics of HIV disease and viral life cycle, the importance of treatment adherence, communications skills, cultural sensitivity, workplace skills, issues of stigma, patient confidentiality, and boundaries of the peer role. As they are introduced into the clinic setting, new peer educators are teamed with more experienced colleagues until they feel confident in their role.
Better quality of life
Using peer educators has benefitted the clinic in many ways, including better informed patients, reduced no-shows or missed appointments, and increased adherence to treatment. As of fiscal year 2006, 73% of all patients in the program are on antiretroviral therapy. Of those, 90% have medical appointments every three months and 97% have completed their viral load laboratory tests, with a result of 53% nondetectable viral loads. But beyond the numbers, the clinic’s HIV-positive peers provide a living example to patients that people can live productive and fulfilling lives while managing HIV disease.
The program also transforms the peer educators themselves, according to Neville. “The program does incredible things for our peers’ self-confidence and self-worth. They are active participants in this world, making a difference in people’s lives.”
