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Peer Support and the HIV Continuum of Care: Results from a Multi-Site Randomized Clinical Trial in Three Urban Clinics in the United States

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Abstract

Racial/ethnic minorities living with HIV and behavioral health co-morbidities are more likely to be disengaged from HIV primary care. Peer programs have been effective in HIV outreach and prevention but effectiveness of such programs for retention in care and viral suppression is understudied. Subjects (n = 348) were randomized in equal allocation to a peer navigation and education intervention versus standard clinical care at three urban clinics in the United States. The intervention group received seven structured interventions plus weekly contact to address medical and social needs. Primary outcomes included time-to-first 4-month gap in HIV care and viral suppression up to 12 months of follow-up. Intention-to-treat analysis showed no difference between groups on 4-month gap in HIV primary care, but subgroup analysis showed a suggestive effect of the peer intervention in reducing gaps in care among stably housed subjects. Fully compliant subjects in the peer intervention experienced significantly fewer 4-month gaps in HIV primary care (p < 0.0001). Those in the peer group who had more clinical face-to-face encounters in the first 3 months were also significantly more likely to have better retention in care (p = 0.04). There were no significant differences between any study subgroups in viral suppression at 12 months. Peer interventions may improve retention in primary care among subgroups of people living with HIV from racial/ethnic minority communities, although such improved retention may not increase viral load suppression. Attending and completing structured educational sessions along with early, intensive contact with peers could improve retention in HIV primary care for patients. Future peer programs should consider training on housing referral systems to help increase retention for patients who are not stably housed. clinicaltrials.gov registration number: NCT01616940.

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Acknowledgements

This study was supported by Grant number, U69HA23262, “Minority AIDS Initiative Retention and Re-Engagement Project,” through the U.S. Department of Health and Human Services, Health Resources and Services Administration’s HIV/AIDS Bureau, National Training and Technical Assistance. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the views of the funding agencies or the U.S. government. The authors would also like to thank all of the peers for their contributions to this study. We also would like to acknowledge the contributions of the following members of the intervention and research teams: Christine Chaisson, Clara Chen, Donald Allensworth-Davies, and Carol Tobias of the Evaluation and Technical Assistance Center at Boston University School of Public Health; Janet Goldberg, Nancy Daniels, Lisa Khaleque, Tammy Gilliam, and Shaquana Simpson of the Brooklyn PATH Center; Carolyn McKay, Patty Valdez, Louis Torres, Lloyd Vela, Tommy Gonzalez of CARE Resources of Miami; Rosaura Lopez, Fressy Veloz, Carmen Rivera, Jesus del Valle, Nathania Garcia Sanyet, Christian Zalazar of Puerto Rico CoNCRA; Alicia Downes of the Kansas City Care Clinic; and Carmen Negron and John Ruiz of the Justice Resource Institute.

Funding

This study was funded from 2011 to 2013 by the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA) as a Special Projects of National Significance Program and the Minority AIDS Initiative, Grant number U69HA23262.

Author information

Authors and Affiliations

  1. Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118, USA

    Howard J. Cabral & Kendra Davis-Plourde

  2. Center for the Advancement of Health Policy and Practice, Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA

    Howard J. Cabral, Kendra Davis-Plourde, Mariana Sarango, Jane Fox & Serena Rajabiun

  3. Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA

    Joseph Palmisano

Authors
  1. Howard J. Cabral
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  2. Kendra Davis-Plourde
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  3. Mariana Sarango
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  4. Jane Fox
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  5. Joseph Palmisano
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  6. Serena Rajabiun
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Corresponding author

Correspondence to Howard J. Cabral.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

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

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

We dedicate this manuscript to the memory of Tammy Gilliam, whose commitment and devotion to her patients and her family was an inspiration to all.

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Cabral, H.J., Davis-Plourde, K., Sarango, M. et al. Peer Support and the HIV Continuum of Care: Results from a Multi-Site Randomized Clinical Trial in Three Urban Clinics in the United States. AIDS Behav 22, 2627–2639 (2018). https://doi.org/10.1007/s10461-017-1999-8

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  • DOI: https://doi.org/10.1007/s10461-017-1999-8

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