Boston, Massachusetts, United States of America

Jim Yong Kim speaks at the Brigham.

Prevention and Access to Care and Treatment (PACT)

The community health plan implemented by Partners in Health in Cange, Haiti, was so successful that it has been utilized in the United States of America. The program is called Prevention and Access to Care and Treatment (PACT). It was adapted from the model applied in Haiti that employs community health workers to perform house visits to HIV patients weekly if not daily. These community health workers ensure that patients are taking their medications, and have access to any other needs as well as proper social services. In addition to community health workers, PACT trains people from at-risk communities to become prevention and harm reduction leaders. The leaders go to educational and support activities with drug users to educate them and help them avoid getting HIV/AIDS.

PACT serves the poor inner-city communities in Boston. Most of the patients are people of color. Many of those whom PACT serves struggle with mental illness, drug or alcohol addictions, racial and language barriers, and social isolation. Many of the patients are homeless, and almost all live in poverty. Every patient has had antiretroviral medications prescribed, but many do not regularly take them. In spite of these circumstances, PACT's community-based approach to AIDS/HIV in Boston has been successful both in improving health status of patients and in reducing costs for treatments. It has been shown that patients enrolled in the PACT program for one year experience an average increase in CD4 count (a way of measuring immune system strength) from a dabgerously low 133 cells per microliter to good levels of 293 cells per microliter. In addition, one hospital in the Boston area reported that patients enrolled in PIH's PACT program are hospitalized 17% less and cost 37% less to care for.

The success of PACT in Boston has become a model for HIV programs in other communities without easily-accessible health care. As of 2006, PACT had expanded its outreach programs to several other poor communities north of Boston. PACT has also been supporting efforts to adapt its community-based prevention model to other areas in the United States such New York City, Madison, Wisconsin, Miami, and Puerto Rico.