HIV Patient Navigation in the United States: A Qualitative Meta-Synthesis of Navigators’ Experiences

Abstract

Patient navigation is increasingly used to link and (re)engage persons with human immunodeficiency virus (HIV) to care. A more holistic understanding of patient navigation can be achieved by exploring the experiences of navigators, the persons who comprise half of the navigation process. We conducted a meta-synthesis of navigator experiences with HIV patient navigation using a phenomenological approach. We identified nine relevant studies. Data were analyzed using thematic synthesis. Analysis identified two overarching themes relating to (1) the breadth and depth of bidirectional relationships and functional activities that navigators undertake to connect their clients to care and (2) the inherently personal experience of delivering navigation services. From these thematic findings, we recommend that HIV patient navigators exhibit capacity and expertise in developing and maintaining interpersonal relationships with clients and health care systems/providers and develop self-care practices and emotional boundaries with clients. Our review seeks to advance public health research and practice by articulating key experiences and perspectives of HIV patient navigators, drawing findings and recommendations applicable to the development, implementation, and evaluation of HIV patient navigation.

A Scoping Review of the Empirical Literature on Peer Support for People Living with HIV

“…A similar observation was recently made in a related review. 25 The experiences described in the included studies substantiate the idea that peer supporters contribute as role models among PLHIV. Related studies examining the receivers’ perspective show that meeting a peer supporter builds various types of support and connections to the wider community.…”

“… 23 Unlike the numerous reviews investigating the effectiveness of peer support for PLHIV, few reviews exist on other aspects of this topic, such as the experiences of peers with peer support or the needs of peer supporters. Further, despite the conceptual analysis of peer interventions put forth by Simoni et al 24 and two reviews on providers’ perspectives of peer support, 15 , 25 the scope of empirical research undertaken on peer support for PLHIV remains unclear and there is a need to map the rapidly expanding field of research on this topic. To this end, to better understand the scope of the current state of research and identify research gaps, this scoping review aimed to identify the characteristics of studies investigating peer support for PLHIV and the key results thereof.…”

A Pilot Study of a Patient Navigation Intervention to Improve HIV Pre-exposure Prophylaxis Persistence Among Black/African American Men Who Have Sex With Men

“…Patient navigation interventions have several key components that contribute to their success in improving health outcomes among people living with and affected by HIV infection. [38][39][40] Patient navigators themselves are crucial to the success of these interventions 38 because these individuals must exhibit capacity and expertise in developing and maintaining interpersonal relationships with clients and health care systems while developing self-care practices and emotional boundaries with clients during their activities. 39 The most common activities for patient navigators are accompanying patients to medical appointments, educating patients about health and health services, collaborating with other professionals to coordinate care, linking patients to care, arranging transportation and other instrumental support, and referring patients to services.…”

“…[38][39][40] Patient navigators themselves are crucial to the success of these interventions 38 because these individuals must exhibit capacity and expertise in developing and maintaining interpersonal relationships with clients and health care systems while developing self-care practices and emotional boundaries with clients during their activities. 39 The most common activities for patient navigators are accompanying patients to medical appointments, educating patients about health and health services, collaborating with other professionals to coordinate care, linking patients to care, arranging transportation and other instrumental support, and referring patients to services. 40 In this study, the flexible nature of the initial patient navigation session allowed the PrEP navigator to perform each of these activities to varying degrees depending on an individual patient's needs, resulting in a highly personalized intervention which allowed patients to build rapport and trust with the PrEP navigator and build confidence in their ability to overcome any actual or perceived barriers.…”

Health Care Providers’ Views on Clinic Infrastructure and Practice Models That May Facilitate HIV Preexposure Prophylaxis (PrEP) Prescribing: A Qualitative Meta-Synthesis

“…For the analysis of texts to identify barriers and facilitators of PrEP prescribing, we used thematic synthesis that involved coding of qualitative data and analysis of coded data through iterative process to regroup and identify overarching themes (Thomas & Harden, 2008). The lead author and a coauthor developed a codebook by randomly selecting four citations and independently coding secondary data (defined as authors' interpretations of the primary data; Roland et al, 2019Roland et al, , 2022Zimmer, 2006) in the result sections from these citations, and meeting to discuss the codes identified and resolving disagreements. Four coders (including the lead and coauthor who developed the codebook) pilot tested these original codes to further refine the codebook, and a pair of coders subsequently coded secondary data from all citations using the refined codebook.…”