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Personal approach to HIV

'You can't really deliver good care unless you understand and are willing to accommodate the whole context of the individual,' said Dr. Heidi Louise Behforouz. "You can't really deliver good care unless you understand and are willing to accommodate the whole context of the individual," said Dr. Heidi Louise Behforouz. (Suzanne Kreiter/Globe Staff)
By Karen Weintraub
Globe Correspondent / October 3, 2011

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WHO

Dr. Heidi Louise Behforouz

WHAT

Behforouz heads an HIV-treatment organization called Prevention and Access to Care and Treatment (PACT), a project of Brigham and Women's Hospital, and the global health provider Partners in Health.

Q. Your group focuses on helping people with HIV, the virus that causes AIDS, who have not been helped by other programs, right?

A. We are referred HIV/AIDS patients who are “failing standard care’’ from 25 different places and hospitals across the country. Patients typically are very sick - they’re immuno-compromised, they’ve had lots of opportunistic illnesses, multiple case managers, a string of hospitalizations and emergency room trips for preventable illness.

Q. What do you do to help them?

A. We assign them a community health worker who does a lot of home-based skill-building, social-support building, life-negotiating skills-building, but also accompanying them into the clinic to make sure the clinician understands when they’re making treatment recommendations what’s happening in the patients’ life.

Q. This idea of a community health worker comes from work Partners in Health has done in Haiti, but you’ve brought it to Boston?

A. We believe in an “accompagnateur’’ approach - it’s French for “to accompany.’’ Our community health workers walk with individuals, as they experience life with poverty and illness. You can’t really deliver good care unless you understand and are willing to accommodate the whole context of the individual. We feel the person most uniquely qualified to do that is a community health worker - someone derived from the affected community who lives many of the realities that our vulnerable patients face. Who not only can talk the talk but walk the walk.

Q. What can community health workers do for patients that conventional health care providers can’t or don’t?

A. A community health worker can [go] with the person to their pantry and talk about what the person can afford or how they learned to cook or what feels like a healthy meal to them, and really work with them - go with them into the grocery store. Teach them how to read labels, cook together, do walking together. Really help implement those changes in their lives in a way that you can’t do in the artificial setting of the clinic.

Q. How do you know this approach works?

A. What we found is that 70 percent of the patients referred to us have tremendous improvements in health outcomes: return to work, regain custody of their children, we see their immune systems improving. When we did an analysis of total medical costs in 70 patients for whom we had two years of data, we saw a 60 percent reduction in hospitalizations and 35 percent reduction in total medical expenditures. This model has been proven effective.

Q. Have you thought about expanding this approach to other diseases?

A. We did a trial at Codman Square integrating community health workers into their diabetes care team and found again that within six months there was a significant clinical improvement in the cohort assigned a community health worker.

Q. So the goal now is to bring it up to a scale where this kind of care can be provided for other conditions and in other parts of the country?

A. What PACT is trying to do now is figure out how we package all of this - make as much of it standardizable as possible. [Our hope is that] this can be embedded in every primary-care setting, and maybe one day obviate the need for all the behemoth hospitals that are being built, because we’ve really strengthened primary care and community care.

This interview has been edited and condensed. Karen Weintraub can be reached at Karen@KarenWeintraub.com.

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