Can lay health workers promote better medical self-management by persons living with HIV? An evaluation of the Positive Choices program

Alexis M. Roth, Ann M. Holmes, Timothy E. Stump, Matthew C. Aalsma, Ronald T. Ackermann, Theodore S. Carney, Barry P. Katz, Joseph Kesterson, Sharon M. Erdman, Christine A. Balt, Thomas S. Inui

Research output: Contribution to journalArticle

11 Scopus citations


Objective: To evaluate Positive Choices (PC), a program that employed lay health workers to motivate antiretroviral adherence among persons living with HIV with coverage from Indiana's high-risk insurance pool. Methods: Four hundred and forty nine participants living in the greater Indianapolis area were randomly allocated to treatment (n=91) or control (n=358) groups and followed for one year. Results: Compared to control subjects, PC subjects were more likely to adhere to HIV medications (medication possession ratio adherence ≥0.95, OR. =1.83, p=0.046), and to achieve undetectable viral load (<50. copies/mL, OR. =2.01, p=0.011) in the 12 months following introduction of PC. There were no significant differences observed between groups in any of self-reported health status indicators. Conclusion: Estimates suggest that PC clients were 16% more likely to have undetectable viral loads than clients in standard care. The incremental program cost was approximately $10,000 for each additional person who achieved an undetectable viral load. Practice implications: As persons living with HIV experience greater longevity and healthcare reform expands coverage to these high-risk populations, greater demands will be placed on the HIV-care workforce. Results suggest lay health workers may serve as effective adjuncts to professional care providers.

Original languageEnglish (US)
Pages (from-to)184-190
Number of pages7
JournalPatient Education and Counseling
Issue number1
StatePublished - Oct 1 2012



  • HIV
  • Lay health workers
  • Medication adherence

ASJC Scopus subject areas

  • Medicine(all)

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