Advertisement

AIDS and Behavior

, Volume 23, Supplement 1, pp 5–13 | Cite as

Developing a Patient Navigation Program to Improve Engagement in HIV Medical Care and Viral Suppression: A Demonstration Project Protocol

  • Casey L. SchumannEmail author
  • Ryan P. Westergaard
  • Alison E. Meier
  • Mari L. Ruetten
  • James M. Vergeront
Original Paper

Abstract

Individuals diagnosed and living with HIV who are out of care or who have persistent viremia are at risk for poor health outcomes and are estimated to account for two-thirds of all new HIV infections. As part of a six-state demonstration project to improve access to care for hard-to-reach populations, Wisconsin developed an HIV-specific patient navigation program to improve engagement in HIV care and viral suppression for populations at risk for poor HIV care outcomes. Patient navigators worked with individuals who were out of HIV medical care or were at risk of falling out of care over nine months to identify and address barriers to care. This manuscript describes the patient navigation program and rationale, and lessons learned that should be considered by sites developing similar programs.

Keywords

Navigation Case management HIV Retention Viral suppression 

Notes

Acknowledgements

This project was supported by Grants from the Health Resources and Services Administration, HIV/AIDS Bureau, under its Special Projects of National Significance, H97HA22698, and the Ryan White HIV/AIDS Part B Program, X07HA00027 and X08HA28015.

Compliance with Ethical Standards

Ethical Considerations

The implementation and evaluation of the patient navigation program does not constitute human subjects research under 45 CFR 46.102 (d) per the University of Wisconsin-Madison Health Sciences Institutional Review Board.

References

  1. 1.
    Centers for Disease Control and Prevention. Selected national HIV prevention and care outcomes in the United States. 2016. http://www.cdc.gov/hiv/pdf/library/factsheets/cdc-hiv-national-hiv-care-outcomes.pdf. Accessed 9 Sep 2016.
  2. 2.
    INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795–807.CrossRefGoogle Scholar
  3. 3.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.CrossRefGoogle Scholar
  4. 4.
    Bradley H, Hall HI, Wolitski RJ, et al. Vital signs: HIV diagnosis, care, and treatment among persons living with HIV—United States, 2011. MMWR Morb Mortal Wkly Rep. 2014;63(47):1113–7.Google Scholar
  5. 5.
    Skarbinski J, Rosenberg E, Paz-Bailey G, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–96.CrossRefGoogle Scholar
  6. 6.
    Safren SA, Mayer KH, San-San O, et al. Adherence to early antiretroviral therapy: results from HPTN 052, a phase III, multinational randomized trial of ART to prevention HIV-1 sexual transmission in serodiscordant couples. J Acquir Immune Defic Syndr. 2015;69(2):234–40.CrossRefGoogle Scholar
  7. 7.
    Horstmann E, Brown J, Islam F, Buck J, Agins BD. Retaining HIV-infected patients in care: where are we? Where do we go from here? Clin Infect Dis. 2010;50(5):752–61.Google Scholar
  8. 8.
    Giordano TP, Gifford AL, White AC, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.CrossRefGoogle Scholar
  9. 9.
    Mugavero MJ, Westfall AO, Cole SR, et al. Beyond core indicators of retention in HIV care: missed clinic visits are independently associated with all-cause mortality. Clin Infect Dis. 2014;59(10):1471–9.CrossRefGoogle Scholar
  10. 10.
    Ulett KB, Willig JH, Lin HY, et al. The therapeutic implications of timely linkage and early retention in HIV care. AIDS Patient Care STDS. 2009;23(1):41–9.CrossRefGoogle Scholar
  11. 11.
    Holtzman CW, Shea JA, Glanz K, et al. Mapping patient-identified barriers and facilitators to retention in HIV care and antiretroviral therapy adherence to Andersen’s Behavioral Model. AIDS Care. 2015;27(7):8127–8.CrossRefGoogle Scholar
  12. 12.
    Aidala AA, Wilson MG, Shubert V, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review. AJPH. 2016;106(1):e1–23.CrossRefGoogle Scholar
  13. 13.
    Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38(5):976–93.CrossRefGoogle Scholar
  14. 14.
    Tobias CR, Cunningham W, Cabral HD, et al. Living with HIV but without medical care: barriers to engagement. AIDS Patient Care STDS. 2007;21(6):426–34.CrossRefGoogle Scholar
  15. 15.
    Institute for Healthcare Improvement. The breakthrough series: IHI’s collaborative model for achieving breakthrough improvement. 2003. http://www.ihi.org/resources/Pages/IHIWhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchievingBreakthroughImprovement.aspx. Accessed 6 May 2016.
  16. 16.
    Harold P. Freeman Patient Navigation Institute. Frequently asked questions. http://www.hpfreemanpni.org/faq/. Accessed 13 May 2016.
  17. 17.
    Freeman HP. Patient navigation: a community based strategy to reduce cancer disparities. J Urban Health. 2006;83(2):139–41.CrossRefGoogle Scholar
  18. 18.
    Natale-Pereira A, Enard KR, Nevarez L, Jones LA. The role of patient navigators in eliminating health disparities. Cancer. 2011;117(15 Suppl):3543–52.Google Scholar
  19. 19.
    Health Resources and Services Administration. Ryan White HIV/AIDS program services: eligible individuals & allowable uses of funds. Policy Clarification Notice #16-02. http://hab.hrsa.gov/sites/default/files/hab/Global/service_category_pcn_16-02_final.pdf. Accessed 11 Nov 2016.
  20. 20.
    Wisconsin Department of Health Services. HIV Medical Case Management: practice standards and administrative guidelines. 2016. https://www.dhs.wisconsin.gov/publications/p0/p00829.pdf.
  21. 21.
    Willis S, Castel AD, Ahmed T, Olejemeh C, Frison L, Kharfen M. Linkage, engagement, and viral suppression rates among HIV-infected persons receiving care at medical case management programs in Washington, D.C. J Acquir Immune Defic Syndr. 2013;64(Suppl 1):S33–41.CrossRefGoogle Scholar
  22. 22.
    Gilman B, Hidalgo J, Thomas C, Au M, Hargreaves M. Linkages to care for newly diagnosed individuals who test HIV positive in nonprimary care settings. AIDS Patient Care STDS. 2012;26(3):132–40.CrossRefGoogle Scholar
  23. 23.
    Bradford JB, Coleman S, Cunningham W. HIV system navigation: an emerging model to improve HIV care access. AIDS Patient Care STDS. 2007;(Suppl 1):S49–58.Google Scholar
  24. 24.
    Broaddus MR, Hanna CR, Schumann C, Meier A. “She makes me feel that I’m not alone”: linkage to care specialists provide social support to people living with HIV. AIDS Care. 2015;27(9):1104–7.CrossRefGoogle Scholar
  25. 25.
    Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas—2013. HIV Surveillance Supplemental Report 2015;20(2). http://www.cdc.gov/hiv/library/reports/surveillance/. Accessed 16 May 2016.
  26. 26.
    Singh S, Bradley H, Hu X, et al. Men living with diagnosed HIV who have sex with men: progress along the continuum of HIV care—United States, 2010. MMWR Morb Mortal Wkly Rep. 2014;63(38):829–33.Google Scholar
  27. 27.
    Hall HI, Gray KM, Tang T, et al. Retention in care of adults and adolescents living with HIV in 13 U.S. areas. J Acquir Immune Defic Syndr. 2012;60(1):77–82.CrossRefGoogle Scholar
  28. 28.
    Baillargeon J, Giordano TP, Rich JD, et al. Accessing antiretroviral therapy following release from prison. JAMA. 2009;301(8):848–57.CrossRefGoogle Scholar
  29. 29.
    Springer SA, Friedland GH, Doros G, Pesanti E, Altice FL. Antiretroviral treatment regimen outcomes among HIV-infected prisoners. HIV Clin Trials. 2007;8(4):205–12.CrossRefGoogle Scholar
  30. 30.
    Westergaard RP, Kirk GD, Richesson DR, Galai N, Mehta SH. Incarceration predicts virologic failure for HIV-infected injection drug users receiving antiretroviral therapy. Clin Infect Dis. 2001;53(7):725–31.CrossRefGoogle Scholar
  31. 31.
    Milloy MJ, Kerr T, Buxton J, et al. Dose-response effect of incarceration events on nonadherence to HIV antiretroviral therapy among injection drug users. J Infect Dis. 2011;203(9):1215–21.CrossRefGoogle Scholar
  32. 32.
    Gardner LI, Metsch LR, Anderson-Mahoney P, et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS. 2005;19(4):423–31.CrossRefGoogle Scholar
  33. 33.
    DHHS Panel on Clinical Practices for Treatment of HIV Infection. Guidelines for the use of antiretroviral agent in HIV-infected adults and adolescents. 2005. https://aidsinfo.nih.gov/contentfiles/adultandadolescentgl04072005001.pdf. Accessed 16 May 2016.
  34. 34.
    Thakkar J, Kurup R, Laba TL, et al. Mobile telephone text messaging for medication adherence in chronic disease: a meta-analysis. JAMA Intern Med. 2016;176(3):340–9.CrossRefGoogle Scholar
  35. 35.
    Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med. 2009;36(2):165–73.CrossRefGoogle Scholar
  36. 36.
    Pew Research Center. Teens, smartphones & texting. 2012 http://www.pewinternet.org/files/old-media//Files/Reports/2012/PIP_Teens_Smartphones_and_Texting.pdf. Accessed 15 Nov 2016.
  37. 37.
    Broaddus M, Dickson-Gomez J, Kelly J, Quinn K, Reed S., Rivas R. Continuity of services, continuity of care: challenges of provider turnover and program discharge for people living with HIV. Poster presented at: The International Association of Providers of AIDS Care, International Conference on HIV Treatment and Prevention Adherence, May 2016, Fort Lauderdale, FL.Google Scholar
  38. 38.
    Irvine MK, Chamberlin SA, Robbins RS, et al. Improvements in HIV care engagement and viral load suppression following enrollment in a comprehensive HIV care coordination program. Clin Infect Dis. 2015;60(2):298–310.CrossRefGoogle Scholar
  39. 39.
    Sullivan KA, Schultz K, Ramaiya M, Berger M, Parnell H, Quinlivan EB. Experiences of women of color with a nurse patient navigation program for linkage and engagement in HIV care. AIDS Patient Care STDS. 2015;29(Suppl 1):S49–54.CrossRefGoogle Scholar
  40. 40.
    Koester KA, Morewitz M, Perason C, et al. Patient navigation facilitates medical and social services engagement among HIV-infected individuals leaving jail and returning to the community. AIDS Patient Care STDS. 2014;28(2):82–90.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Casey L. Schumann
    • 1
    • 4
    Email author
  • Ryan P. Westergaard
    • 2
  • Alison E. Meier
    • 3
  • Mari L. Ruetten
    • 1
  • James M. Vergeront
    • 1
  1. 1.AIDS/HIV Program, Division of Public HealthWisconsin Department of Health ServicesMadisonUSA
  2. 2.Division of Infectious Disease, Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  3. 3.University of Wisconsin Medical FoundationMadisonUSA
  4. 4.MadisonUSA

Personalised recommendations