Engaging HIV-positive clients in care: acceptability and mechanisms of action of a peer navigation program in South Africa

Abstract

Antiretroviral therapy (ART) could curtail the HIV epidemic, but its impact is diminished by low uptake. We developed a peer navigation program to enhance engagement in HIV care, ART adherence, and behavioral prevention. In preparation for a randomized controlled trial, the program was piloted over four months at two primary health clinics in South Africa's North West Province. Newly diagnosed, HIV-positive clients met regularly with navigators to address barriers to care, adherence, and prevention. To assess program acceptability and feasibility and characterize the mechanisms of action, we surveyed 25 clients who completed navigation services and conducted interviews with 10 clients, four navigators, and five clinic providers. Clients expressed near universal approval for the program and were satisfied with the frequency of contact with navigators. HIV stigma emerged as a primary driver of barriers to care. Navigators helped clients overcome feelings of shame through education and by modeling how to live successfully with HIV. They addressed discrimination fears by helping clients disclose to trusted individuals. These actions, in turn, facilitated clients' care engagement, ART adherence, and HIV prevention efforts. The findings suggest peer navigation is a feasible approach with potential to maximize the impact of ART-based HIV treatment and prevention strategies.

Treatment adherence in HIV stigmatized environments in South Africa: stigma avoidance and medication management

“…6,9 Counseling patients to replace adherence-impeding stigma–medication management strategies with alternative medication routines that address stigma concerns may be implemented by lay counselors. 37…”

Understanding the role of resilience resources, antiretroviral therapy initiation, and HIV-1 RNA suppression among people living with HIV in South Africa

“…Interventions targeting this mechanism may provide a pathway toward training peers or partners to support PLWH in nonjudgmental and nonconfrontational ways (e.g. using motivational interviewing techniques), and may ultimately be effective in helping PLWH to initiate and stay on ART, as has been previously suggested [57,58].…”

Increasing Mental Health Engagement From Primary Care: The Potential Role of Family Navigation

“…76 Navigation may also be beneficial for patients with diagnoses that are socially stigmatized and where stigma represents a barrier to care. 77 For example, participants in a peer navigation program for patients who were HIV-positive reported that navigators were an important source of support, particularly in addressing psychological barriers, such as fear and shame, and for those who had not disclosed their diagnosis. 77,78 Navigation programs have also been associated with increased service use, including linkages to care, adherence to recommended testing and treatment, and timeliness in obtaining health care services, even for patients who are at high risk for delays in care.…”

“…77 For example, participants in a peer navigation program for patients who were HIV-positive reported that navigators were an important source of support, particularly in addressing psychological barriers, such as fear and shame, and for those who had not disclosed their diagnosis. 77,78 Navigation programs have also been associated with increased service use, including linkages to care, adherence to recommended testing and treatment, and timeliness in obtaining health care services, even for patients who are at high risk for delays in care. 44,45,64,[79][80][81] In a meta-analysis of randomized controlled trials (RCTs) of navigation to improve health care use (most were focused on adult patients with cancer), pooled analysis revealed that navigation increased the likelihood of health screening uptake by 2.5 times and attendance at recommended appointments by almost 3 times.…”