Community health workers and promotores de salud: a tiered framework for infectious disease prevention and care among California agricultural workers
- 1Clovis North High School , , ,
- 2Department of Public Health, University of California, Merced , , ,
- 3Division of Infectious Diseases, Department of Medicine, University of California, San Francisco , , ,
Abstract
Agricultural workers in the United States face a disproportionate burden of infectious diseases, including tuberculosis, HIV, coccidioidomycosis, viral hepatitis, and COVID-19, driven by occupational exposures, crowded housing, poverty, and limited healthcare access. Despite this burden, farmworkers have among the lowest rates of healthcare utilization of any US working population, and traditional clinic-based delivery models are poorly suited to the realities of agricultural labor. Community health workers (CHWs), known as promotores de salud in Latino communities, offer a well-established strategy for bridging this gap through shared language, culture, and lived experience with the communities they serve. This mini-review synthesizes evidence on CHW and promotora interventions for infectious disease prevention and care among agricultural workers, with particular attention to California's farmworker communities. Available evidence supports CHW roles in COVID-19 vaccination and outreach, tuberculosis treatment adherence through community-based directly observed therapy, HIV prevention and pre-exposure prophylaxis (PrEP) navigation, and hepatitis screening and linkage to care. However, existing programs have largely operated in isolation, and, to our knowledge, no CHW intervention for coccidioidomycosis has been developed despite its importance as an occupational infectious disease in California. To address this fragmentation, we propose a three-tiered framework that extends CHW roles from community-based prevention and early recognition to screening, linkage, and treatment support, and ultimately to formal integration with healthcare and public health systems. Implementing this framework will require infectious disease-specific training in the languages of the communities served, sustainable financing, and rigorous evaluation of an integrated cross-disease CHW model in California's agricultural communities.
Related
- Community-based infectious disease prevention awareness through children's creative works: outreach embedded in school-based action research
- Critical gaps in infectious disease prevention and control: insights from IHR-2005 implementation enablers and challenges at key entry points in Bangladesh
- Unmet health and social service needs in LGBTQ+ older adults in California: a quantitative analysis of a large community-based sample
- Health literacy, adherence to prevention practices, and attitudes towards caring for infectious patients among medical and nursing students - a cross-sectional study
- Effectiveness of community-based care pathways and relapse prevention strategies in schizophrenia: a systematic review and bibliometric analysis
BibTeX
@article{kasturi2026community,
title = {{Community health workers and promotores de salud: a tiered framework for infectious disease prevention and care among California agricultural workers}},
author = {Kaivalya Kasturi and Nancy Burke and Geetha Sivasubramanian},
journal = {Frontiers in public health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1972841},
url = {https://europepmc.org/article/PMC/PMC13673139},
note = {CC BY},
}
RIS
TY - JOUR
TI - Community health workers and promotores de salud: a tiered framework for infectious disease prevention and care among California agricultural workers
AU - Kaivalya Kasturi
AU - Nancy Burke
AU - Geetha Sivasubramanian
PY - 2026
DA - 2026/10/02
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1972841
UR - https://europepmc.org/article/PMC/PMC13673139
AB - Agricultural workers in the United States face a disproportionate burden of infectious diseases, including tuberculosis, HIV, coccidioidomycosis, viral hepatitis, and COVID-19, driven by occupational exposures, crowded housing, poverty, and limited healthcare access. Despite this burden, farmworkers have among the lowest rates of healthcare utilization of any US working population, and traditional clinic-based delivery models are poorly suited to the realities of agricultural labor. Community health workers (CHWs), known as promotores de salud in Latino communities, offer a well-established strategy for bridging this gap through shared language, culture, and lived experience with the communities they serve. This mini-review synthesizes evidence on CHW and promotora interventions for infectious disease prevention and care among agricultural workers, with particular attention to California's farmworker communities. Available evidence supports CHW roles in COVID-19 vaccination and outreach, tuberculosis treatment adherence through community-based directly observed therapy, HIV prevention and pre-exposure prophylaxis (PrEP) navigation, and hepatitis screening and linkage to care. However, existing programs have largely operated in isolation, and, to our knowledge, no CHW intervention for coccidioidomycosis has been developed despite its importance as an occupational infectious disease in California. To address this fragmentation, we propose a three-tiered framework that extends CHW roles from community-based prevention and early recognition to screening, linkage, and treatment support, and ultimately to formal integration with healthcare and public health systems. Implementing this framework will require infectious disease-specific training in the languages of the communities served, sustainable financing, and rigorous evaluation of an integrated cross-disease CHW model in California's agricultural communities.
SN - 2296-2565
ER -