PACT Update: From HIV/AIDS to chronic diabetes

When “Joe” was given three new pills to control chronic diabetes, the prescriptions became just another page in an already large case file. A gregarious 51-year-old man from Dorchester, MA, Joe takes 22 different medications for a dizzying array of ailments—many of them either directly or indirectly related to his being a diabetic. One major barrier to successful diabetes management was his poor knowledge about the disease—the importance of healthy eating and exercise, and also how to take his medicines.

Joe’s doctor could not give him this level of support. Fortunately, he was assigned a community health worker through the Prevention and Access to Care and Treatment Project (PACT)—a joint effort of Brigham and Women’s Hospital and Partners In Health (PIH).

The community health worker discovered that because Joe did not understand the difference between his three diabetes medicines, he was only taking two of the pills, greatly diminishing the regimen’s effectiveness. She explained how they work together and helped Joe manage the sudden drop in blood sugar that resulted when he started taking all three medicines. Joe’s clinical status improved dramatically.

The community health worker also helped him define individual goals and outline action steps to guide his success. One of Joe’s major achievements has been enrollment in a physical therapy program at the Dorchester House, allowing him to exercise for the first time in years.

An objective of health reform is to revolutionize the relationship between those receiving care and those providing it, focusing on an individual’s capabilities rather than just his or her needs. As Joe’s case illustrates, community health workers have a key role to play.

Adapting a model that PIH has so successfully used to fight HIV in rural Haiti and drug-resistant tuberculosis in Peru, PACT has for many years employed community health workers to provide home-based services to the sickest and most marginalized people living with HIV in and around Boston. Community health workers are members of the local community who are trained to provide medical and psychosocial support for their neighbors. In addition, delivering services through community health workers is one way to help relieve the current urgent health workforce shortage—in both the United States and in the communities PIH serves around the world.

The proven effectiveness of using community health workers to help treat and manage infectious diseases like HIV/AIDS and tuberculosis is now being tested by PACT to treat a chronic disease—diabetes.

As countries become more affluent and people adopt richer diets and more sedentary lifestyles, chronic diseases impose an increasingly heavy burden in death, disability, and medical costs. The search for cost-effective ways to treat diabetes and other chronic diseases has become a major priority, especially for a country like the United States, where an estimated 21 million people have diabetes.

One of the community health workers first tasks with any new patient is to educate that patient about their disease and how they can improve their health. PACT has designed a diabetes curriculum to improve the knowledge and skills of diabetic patients in order to empower them for successful self-management. 

Working with a small group of patients, the community health workers teach lessons relevant to successful diabetes management, including: healthy eating, monitoring medications, reducing risks of complications, staying active, and goal setting. Patients also learn about navigating the health care system and practice useful coping strategies for stressful situations.

The initiative began enrolling patients and administering baseline surveys last November: 76 patients have been enrolled to date and will participate in the program for 12 months; 32 of these patients are now working with a community health worker, with enrollment increasing on a weekly basis.