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

Abstract

We (1) estimated the prevalence of not getting patient navigation despite feeling a need for the service (unmet subjective need) or despite having unsuppressed viral load (unmet objective need) among people with HIV (PWH), (2) determined reasons why PWH did not use the service, and (3) determined factors associated with unmet need for patient navigation. We used combined data from the 2015 to 2017 cycles of the Medical Monitoring Project, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of adults with diagnosed HIV infection in the United States. Six percent reported unmet subjective need and 28% had unmet objective need for patient navigation. When needs were combined, more than a third had unmet need for the service. Among PWH with unmet subjective need for patient navigation, 77% reported lack of knowledge about patient navigation as a reason for nonuse. Younger age, female gender, racial/ethnic minority status, limited health literacy, homelessness, incarceration history, lack of health insurance/coverage, noninjection drug use, depression, and recent HIV diagnosis were associated with unmet subjective or objective need for patient navigation. One in three PWH did not use patient navigation despite needing the service. Lack of knowledge about patient navigation was a barrier to use, calling for increased availability, and promotion of such services. PWH with social and economic vulnerabilities were less likely to get patient navigation when needed. It is important to address the question of how to make this service available to everyone who needs it.

Peer navigators' role in supporting people living with human immunodeficiency virus in Australia: Qualitative exploration of general practitioners' perspectives

“…However, there are challenges associated with creating awareness of HIV CHOs and PN programmes across the broader primary care sector. As the number of non‐s100 specialist GPs diagnosing PLHIV continues to increase (Kirby Institute, 2017; Newman et al., 2015), there is an urgent need to foster awareness of and referral pathways to HIV CHOs as essential resources supporting the care of PLHIV (Mizuno et al, 2020).…”

Characteristics of Adults With Diagnosed HIV Who Experienced Housing Instability: Findings From the Centers for Disease Control and Prevention Medical Monitoring Project, United States, 2018

“…Although PLWH experiencing homelessness may have access to Ryan White HIV/AIDS program services (Doshi et al, 2017), a large proportion may have unmet needs for behavioral health services, dental care, access to transportation, and housing services (Dray-Spira et al, 2012; Padilla et al, 2020; Wainwright et al, 2020). Interventions to alleviate unmet needs and improve HIV outcomes, such as intensive case management, patient navigators, and financial incentives, have been initiated in a variety of venues (Clemenzi-Allen et al, 2020; Mizuno et al, 2020; Rajabiun et al, 2018; Sarango et al, 2017). These interventions could benefit people who are unstably housed and who may be potentially at risk for literal homelessness.…”

Examining How Health Navigation Affects Mental Health Among Gay, Bisexual, and Other Men Who Have Sex with Men Living with Human Immunodeficiency Virus in Guatemala

“…Promoting navigation services to clients with high anxiety is essential to ensuring that those with the biggest need are reached, as research in the United States has found that over a third of PLHIV did not use health navigation despite having a need for it. 39 Although our findings suggest that navigation interventions may have a positive impact on anxiety among GBMSM living with HIV, many interactions between a navigator and patient were needed to see a significant effect. This may be cost-prohibitive in some settings.…”