ADULT: COMMUNITY HEALTH WORKER

SORI'S STORY:
In Boston, a community health worker accompanies women living with HIV.

Sori Santana, right, visits a PACT patient in her home.

Every week, Sori Santana travels to the homes of more than a dozen patients living with HIV. As a community health worker with PIH’s Prevention and Access to Care and Treatment (PACT) program, Santana is one of nine health workers who provide daily home visits to 85 of Boston’s most vulnerable HIV patients.

Like Sori herself, the patients she cares for live and work in Boston’s predominantly black and Hispanic Dorchester neighborhood. In a poor, disenfranchised community, people living with HIV often carry the double burden of stigma associated with the disease and with mental illness, substance abuse, and poverty.

Santana helps these patients stick with their complex drug regimen. At the same time, she empowers them through education, advocates for their needs during doctors’ visits, and provides much-needed friendship.

But her job is not to force patients to take their medicine. Santana’s long-term goal is to make herself obsolete, “to empower clients to know that they can do this on their own, they don’t need us.” She is there to listen, to understand, and to provide emotional and practical support.

Empowering the city’s most vulnerable

In Boston, over 15,000 people live with HIV. While this number is relatively low compared to cities like New York, where at least 240,000 people live with the disease, the demographics of those affected reflect a troubling national trend. 

African Americans comprise only six percent of greater Boston’s population but account for 28 percent of those living with HIV. Women in the black community are impacted hardest. A shocking 83 percent of women diagnosed with HIV in Boston are African American.

In Boston's Haitian and Dominican immigrant communities, Santana and her colleagues often contend with a harmful level of misinformation about HIV. Some widely believe that HIV is transmitted by sharing eating utensils and toilets and through mosquito bites. People infected are often stigmatized as sexually promiscuous or homosexual. The cultural weight of these assumptions forces many people to stay quiet about their status.

For many, this isolation can be unbearable. Often it leads to self-destructive behaviors. This is when Santana and PACT’s other community health workers step in.

Sori’s story

As a young mother with three small children, Sori Santana decided to go back to school in order to get off welfare, become independent, and support her family. “I wanted to do something that I felt good about. I always loved helping people... and I found PACT.”

Sori Santana, left, and a fellow PACT health worker, center, talk with a PACT patient as she organizes her weekly medications.

Now, as a directly observed therapy (DOT) specialist, she helps people in her community who are struggling to help themselves. She accompanies patients as they follow complex daily drug regimens, and she connects them to health care and social support programs. 

With a smile, she describes the progress of one of her clients. “Sometimes when I walk in, she says, ‘I don’t feel that I can take my meds today. My stomach’s grumbling and I don’t want to do it. I don’t want to do it!’”

“Then we just start talking about her issues with her daughters, with her mom, with her job, or whatever. I’m just sitting down listening to her,” continued Santana. “And she gets up, grabs her meds, swallows them. And as she’s swallowing them, she says, ‘Oh... I just took my pills! Didn’t I just say I didn’t want to take my pills! Why didn’t you stop me?’”

“So I say, ‘Why should I stop you? I want you to take your pills; I want you to get healthy,’” said Santana. “The client said, ‘You just sat here and kept on talking. You are good.’ And we sit back and laugh about it.”

In 2011, Santana and her eight colleagues at PACT logged 5,160 home visits.

Saving patients, relieving stress on the medical system

Since 1997, PACT has recruited and trained community health workers (CHWs) to accompany Boston’s most vulnerable patients living with chronic diseases like HIV and diabetes. CHWs don't only accompany patients as they reclaim their health and improve their disease-management skills. They also facilitate better relationships between patients and the healthcare system, leading to reductions in costly emergency room visits and hospitalizations.

An analysis of Medicaid claims revealed a 16 percent savings in total medical expenditures two years after patients enroll with PACT. This is attributed to a 35 percent reduction in length of hospital stays and a 60 percent reduction in inpatient costs.

This kind of cost saving is linked to PACT’s focus on integrating CHWs into high-risk patients’ primary care teams. The partnership allows clinics to develop the infrastructure and culture necessary to support interventions for the most vulnerable and high-cost patients.

Enhancing health care delivery for vulnerable patients

Working in a half-dozen sites across the nation, PACT trains organizations to integrate PACT’s CHW delivery model into existing health systems in order to improve the health outcomes of vulnerable populations across the United States.

In 2011, PACT’s small staff trained more than 300 nurses and CHWs.

Learn more about the PACT project.