Patient Navigation Associated With Positive Outcomes in HIV

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Positive care continuum outcomes included linkage to care, retention in care, antiretroviral therapy uptake, medication adherence, and viral suppression.
Positive care continuum outcomes included linkage to care, retention in care, antiretroviral therapy uptake, medication adherence, and viral suppression.

Patient navigation programs in HIV care are positively associated with HIV care continuum outcomes such as maintenance of antiretroviral therapy (ART) and retention in care, according to a study published in AIDS.

Researchers conducted a systematic review of online databases to assess if HIV patient navigation programs provided positive continuum outcomes, such as linkage to care, retention in care, ART uptake, medication adherence, and viral suppression. Studies were identified from MEDLINE (OVID), EMBASE (OVID), PsycINFO (OVID), and CINAHL (EBSCOhost) that included the use of HIV patient navigation or navigation-like services and reported quantitative data assessing the correlation between the service and the outcome. For each eligible study, the researchers assessed study characteristics, patient characteristics, activities of navigator programs, and study results.

Studies were grouped evidentially into 3 categories: positive association (>50% of results showing statistically significant [P <.05] associations between HIV patient navigation and the outcome; mixed result (50% of results showing statically significant positive associations); and null association (<50% of results showing statistically significant positive associations).

A total of 20 studies published between 2005 and 2018 were included in the review, 17 of which found positive associations; 2 (12%) were strong studies, 4 (23%) were moderate, and 11 (65%) were weak. Patient navigation was more likely to be associated with linkage to care (5 of 6 studies that analyzed this association, 83%), retention to care (10 of 11, 91%), ART uptake (1 of 4, 25%), adherence to medication (2 of 4, 50%), and viral suppression (11 of 15 73%); 3 studies reported null associations between patient navigation and HIV care outcomes.

Activities conducted by patient navigators included accompaniment to appointments (12 studies, 71%), appointment coordination (10, 59%), transportation (8, 47%), relationship building (7, 41%), abundance of HIV information (6, 35%) and service coordination (6, 35%). Approximately 29% of studies referred patients to further HIV care or other health services.

“This review suggests that overall, patient navigation, as is presented by the included studies, is positively associated with HIV care continuum outcomes, particularly linkage to and retention in HIV care and viral suppression” the authors concluded.”

Reference

Mizuno Y, Higa DH, Leighton CA, Roland KB, Deluca JB, Koenig LJ. Is HIV patient navigation associated with HIV care continuum outcomes? A systematic review [published online August 9, 2018]. AIDS. doi: 10.1097/QAD.0000000000001987

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