Enhancing Adherence to Care in the HIV Care Continuum: The Barrier Elimination and Care Navigation (BEACON) Project Evaluation

Abstract

Interventions are needed to address each phase of the HIV care continuum in order to improve health outcomes and reduce likelihood of HIV transmission. The purpose of this study was to assess the impact of a community- and clinic-based intervention designed and implemented to reengage individuals who were lost to HIV care. Eligible participants had either never engaged in HIV care or had not had a medical visit for at least 12 months. Participants enrolled in a community- and clinic-based intervention that included intensive case management, access to a community nurse and peer navigator, as well as emergency stabilization funds. Data were collected at baseline and 6-month time points by the case managers; which included sociodemographics, general health, abstracted HIV viral loads and CD4 cell counts from their medical records. Descriptive and GEE analyses were conducted to assess changes from baseline to 6 months. A total of 322 participants enrolled over a 5-year period, of whom the majority were male (n = 250) and African American with a mean age of 42.0 years. After 6 months of the intervention, there was a significant increase of individuals who had undetectable HIV viral loads and their median CD4 cell counts increased (p < 0.01 for both). General health improved as well (p < 0.01). It is clear that this method of engagement, while staff intensive, is successful at engaging and retaining individuals in HIV care at least through 6 months.

Resumen

Se necesitan intervenciones para abordar cada fase del continuo de atención de VIH para mejorar los resultados de la salud y reducir la probabilidad de transmisión del VIH. El propósito de este estudio fue evaluar el impacto de una intervención comunitaria y clínica, diseñado e implementado para comprometerse otra vez personas que perdieron a la atención. Los participantes elegibles había nunca participan en el cuidado del VIH o no había visto un médico durante al menos 12 meses. Los participantes participan en una intervención comunitaria y clínica que incluyen manejo de caso intensivo, acceso a una enfermera de la comunidad y navegador por pares, así como fondos de estabilización de emergencia. Datos se recolectaron al inicio y puntos temporales de 6 meses por los administradores de casos; que incluyó sociodemográficos, salud general, resumieron cargas virales de VIH y recuentos de células CD4 de sus expedientes médicos. Análisis descriptivo y GEE se realizaron para evaluar los cambios desde el inicio a los 6 meses. Un total de 322 participantes inscritos durante un período de 5 años, de los cuales la mayoría era hombres (n = 250) y afroamericanos con una edad promedio de 42,0 años. Después de 6 meses de la intervención, hubo un aumento significativo de los individuos que tenían cargas virales de VIH no detectables y su promedio de células CD4 cuenta creciente (p < 0.01 para ambos). Salud general también mejoraron (p < 0.01). Está claro que este método de participación, mientras que tengan maneja de caso intensivo, tiene éxito en participación y retención de personas en el cuidado del VIH al menos durante 6 meses.

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Funding

This project was supported by a grant from AIDS United. This material is based upon work supported by the Corporation for National and Community Service under Social Innovation Fund Grant No. 10SIHDC001. Opinions or points of view expressed in this document are those of the authors and do not necessarily reflect the official position of, or a position that is endorsed by, the Corporation or the Social Innovation Fund.

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Correspondence to Enbal Shacham.

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All co-authors have no conflicts of interest to report.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was waived, as intervention participants were enrolled in a program at a community-based organization and only unidentifiable data were shared with the researchers.

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Shacham, E., López, J.D., Brown, T.M. et al. Enhancing Adherence to Care in the HIV Care Continuum: The Barrier Elimination and Care Navigation (BEACON) Project Evaluation. AIDS Behav 22, 258–264 (2018). https://doi.org/10.1007/s10461-017-1819-1

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Keywords

  • HIV
  • AIDS
  • Community
  • HIV management
  • Community capacity
  • Community engaged intervention