Patient navigation programmes 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.
Researchers at the division of HIV/AIDS prevention, US Centres for Disease Control and Prevention, Atlanta, 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 (EBSCO host) 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 analysed 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.”
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 [EBSCO host]) 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.
Authors
Yuko Mizuno; Darrel H Higa; Carolyn A Leighton; Katherine B Roland; Julia B Deluca; Linda J Koenig
[link url="https://www.infectiousdiseaseadvisor.com/hivaids/patient-navigation-linked-to-continuation-of-hiv-care/article/792188/"]Infectious Disease Advisor material[/link]
[link url="https://insights.ovid.com/crossref?an=00002030-900000000-97132"]AIDS abstract[/link]