PACT Health Promoter
A PACT health promoter on a home visit to an AIDS patient.

PACT health worker meeting patient
A PACT patient with pillbox.

The Prevention and Access to Care and Treatment (PACT) project serves the sickest and most marginalized HIV patients in Boston. Adapting the accompagnateur model developed in Haiti, PIH’s only domestic healthcare program trains and employs community members to check in on HIV patients on a daily or weekly basis, making sure they attend medical appointments, take their medications and have access to other essential needs and social services. PACT also recruits and trains people from at-risk communities to become prevention and harm reduction leaders, conducting education and support activities with injection drug users to help them avoid becoming infected with HIV.

PACT’s health promotion and directly observed therapy programs target the hardest-to-reach patients – poor people of color living in inner-city Boston neighborhoods who have fallen through the cracks of other healthcare delivery systems. In addition to HIV, they typically struggle with mental illness, drug or alcohol abuse, racial and language barriers, and social isolation. Some are homeless. Almost all live in poverty. All have had antiretroviral medications prescribed but are not taking them regularly if at all.

PACT’s community-based approach has achieved measurable success both in improving health status and in reducing costs. A recent study showed that patients enrolled in the program for 12 months experienced an average increase in CD4 count (a reflection of immune system strength) from a dangerously low 133 cells per microliter to an acceptable level of 293. One Boston-area hospital reported that hospitalizations of high-risk AIDS patients enrolled in the PACT program decreased by 17 percent and the costs for each inpatient stay dropped by 37 percent.

PACT also offers comprehensive peer prevention programs to reduce the risk of HIV infection and substance abuse among one of Boston’s most vulnerable population groups - Latino injection drug users. The Fuerza Latino and Fuerza Latina programs (for men and women respectively) train patients who are in the early stages of recovery from drug use to do education and outreach among their peers.

PACT’s success in improving adherence to treatment and health status in these vulnerable population groups has made it a model for HIV programs in other communities that share the double burden of disease and unequal access to health care that PACT has confronted in Dorchester, Roxbury and other Boston neighborhoods. As of 2006, PACT had expanded its outreach and referral network to several poor communities north of Boston and was supporting efforts to adopt its model of community-based prevention and care at hospitals in New York City, Madison, Wisconsin, and Miami, as well as in Puerto Rico.