Is HIV patient navigation associated with HIV care continuum outcomes?

Abstract

Objective: To provide the first systematic review on the associations between HIV patient navigation and HIV care continuum outcomes (i.e., linkage to care, retention in care, ART uptake, medication adherence, and viral suppression) in the United States (U.S.). We identified primary research studies that addressed these associations and qualitatively assessed whether provision of patient navigation was positively associated with these outcomes, including strength of the evidence. Methods: A systematic review, including both electronic (MEDLINE [OVID], EMBASE [OVID], PsycINFO [OVID], and CINAHL [EBSCOhost]) online databases and manual searches, was conducted to locate studies published from January 1, 1996 through April 23, 2018. Results: Twenty studies met our inclusion criteria. Of these, 17 found positive associations. Patient navigation was more likely to be positively associated with linkage to care (5 of 6 studies that assessed this association), retention in care (10 of 11), and viral suppression (11 of 15) than with antiretroviral (ART) uptake (1 of 4) or ART adherence (2 of 4). However, almost two-thirds of the 17 studies were of weak study quality, and only three used a randomized controlled trial (RCT) design. Conclusions: Available evidence suggests that patient navigation is a potentially effective strategy to enhance engagement in care among persons with HIV (PWH). However encouraging, the evidence is still weak. Studies with more rigorous methodological designs, and research examining characteristics of navigators or navigational programs associated with better outcomes, are warranted given the current interest and use of this strategy.

Pathways to housing stability and viral suppression for people living with HIV/AIDS: Findings from the Building a Medical Home for Multiply Diagnosed HIV-positive Homeless Populations initiative

“…This finding highlights the critical role patient navigators can play as part of the care team in reducing barriers to care and keeping people with HIV experiencing homelessness connected to the health care system for continuity of care. Our findings are similar to those of other studies that found that patient navigation has a significant effect on engagement in care for vulnerable people with HIV at risk for homelessness, such as those leaving incarceration and those who have been out of care for more than six months [22][23][24][25].…”

Is Patient Navigation Used by People with HIV Who Need It? An Assessment from the Medical Monitoring Project, 2015 − 2017

“…Patient navigation is often found to be positively associated with viral suppression. 1 Unmet need increased more than fourfold (6-28%) when using unsuppressed viral load in the past 12 months as an indicator of objective need for patient navigation, illustrating the importance of considering multiple measures of need.…”

“…This program was funded through Ryan White Part A (under the ''medical case management'' service category), and clients were able to access patient navigation services for free if they were enrolled in that program. Given that there is no standard definition of HIV patient navigation, 1 it is unlikely that the service per se would be directly covered by private or public health insurance plans. It is possible that these plans could link PWH to clinics that provide patient navigation as part of their comprehensive HIV care coordination services.…”

“…Those who responded ''no'' or ''I don't know'' and whose medical records indicated that any of their viral load tests were detectable (>200 copies/mL) or had no viral load tests in the past 12 months were coded as having unmet objective need for patient navigation = 1 (yes), and 0 (no) otherwise. Given that patient navigation interventions are often found to be positively associated with viral suppression, 1 we used unsuppressed viral load among those who did not receive navigation services as an objective indicator of need for the service. Lastly, we created a variable that combined unmet subjective need and unmet objective need for patient navigation.…”

“…4 In addition to removing structural and process barriers which providers tend to focus on, 7 patient navigators, specifically peer navigators, can also address relational concerns (e.g., fear, stigma, a lack of social support) of PWH. 7,8 A systematic review 1 showed that patient navigation can enhance linkage to and retention in care and viral suppression among PWH. Patient navigation is a promising strategy, particularly for PWH with a history of incarceration.…”