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Toward An Enhanced Understanding of HIV Patient Navigation as a Health Care Intervention: An Analysis of Navigation in Practice

Abstract

Patient navigation is a promising strategy for improving health among persons with multiple barriers to HIV care, yet little is known about navigation’s core components. From 24 systematically identified navigation studies, we abstracted navigators’ activities, grouped activities into 20 thematic activity categories, and ordered them by frequency. Subsequently, Principal Components Analysis of activity categories was used identify independent clusters. Accompaniment characterized 71% of navigation programs; ≥ half included health education (58%), collaboration/coordination (58%), linkage-to-care (54%), transportation support (54%), service referrals (50%) and instrumental support (50%). Five unique components (comprising 13 activity categories) were identified: (1) services beyond office, (2) health education and relationship building, (3) accompaniment and instrumental support, (4) locating patients and tracking information, and (5) beyond HIV care. Navigators who located patients or tracked information were less likely to provide accompaniment or instrumental support (r = − 0.60, p = 0.002). Findings can enhance precision in developing, describing, evaluating and improving navigation programs.

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References

  1. Centers for Disease Control and Prevention. HIV Surveillance Report, 2018 (updated). 2020. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Accessed 4 Sept 2020.

  2. Centers for Disease Control and Prevention. Characteristics associated with HIV infection among heterosexuals in urban areas with high AIDS prevalence—24 cities, United States, 2006–2007. MMWR Morb Mortal Wkly Rep. 2011;60(31):1045–9.

    Google Scholar 

  3. Pellowski JA, Kalichman SC, Matthews KA, Adler N. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. Am Psychol. 2013;68(4):197–209.

    PubMed  PubMed Central  Google Scholar 

  4. Cook JA, Burke-Miller JK, Steigman PJ, et al. Prevalence, comorbidity, and correlates of psychiatric and substance use disorders and associations with HIV risk behaviors in a multisite cohort of women living with HIV. AIDS Behav. 2018;22(10):3141–54.

    PubMed  PubMed Central  Google Scholar 

  5. Gaynes BN, Pence BW, Eron JJ Jr, Miller WC. Prevalence and comorbidity of psychiatric diagnoses based on reference standard in an HIV+ patient population. Psychosom Med. 2008;70(4):505–11.

    PubMed  PubMed Central  Google Scholar 

  6. Centers for Disease Control and Prevention. HIV Mortality—2018. 2018. https://www.cdc.gov/hiv/pdf/library/slidesets/cdc-hiv-surveillance-mortality-2018.pdf. Accessed 6 Nov 2020.

  7. Bosh KA, Johnson AS, Hernandez AL, et al. Vital signs: deaths among persons with diagnosed HIV infection, United States, 2010–2018. MMWR Morb Mortal Wkly Rep. 2020;69(46):1717–24.

    PubMed  PubMed Central  Google Scholar 

  8. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2014–2018. 2020. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-25-1.pdf. Accessed 4 Sept 2020.

  9. Koenig LJ, Hoyer D, Purcell DW, Zaza S, Mermin J. Young people and HIV: A call to action. Am J Public Health. 2016;106(3):402–5.

    PubMed  PubMed Central  Google Scholar 

  10. 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, 2018. 2020. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-25-2.pdf. Accessed 4 Sept 2020.

  11. Kamitani E, Wichser ME, Adegbite AH, et al. Increasing prevalence of self-reported HIV preexposure prophylaxis use in published surveys: a systematic review and meta-analysis. AIDS (London, England). 2018;32(17):2633–5.

    PubMed Central  Google Scholar 

  12. Marcus JL, Hurley LB, Hare CB, Silverberg MJ, Volk JE. Disparities in uptake of HIV preexposure prophylaxis in a large integrated health care system. Am J Public Health. 2016;106(10):e2–3.

    PubMed  PubMed Central  Google Scholar 

  13. Serota DP, Rosenberg ES, Thorne AL, Sullivan PS, Kelley CF. Lack of health insurance is associated with delays in PrEP initiation among young black men who have sex with men in Atlanta, US: a longitudinal cohort study. J Int AIDS Soc. 2019;22(10):e25399.

    PubMed  PubMed Central  Google Scholar 

  14. Freeman HP, Rodriguez RL. History and principles of patient navigation. Cancer. 2011;117(15 Suppl.):3539–42.

    PubMed  Google Scholar 

  15. Bradford JB, Coleman S, Cunningham W. HIV system navigation: an emerging model to improve HIV care access. AIDS Patient Care STDS. 2007;21(Suppl. 1):S49–58.

    PubMed  Google Scholar 

  16. Farrisi D, Dietz N. Patient navigation is a client-centered approach that helps to engage people in HIV care. HIV Clin. 2013;25(1):1–3.

    PubMed  Google Scholar 

  17. Thompson MA, Mugavero MJ, Amico KR, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Ann Intern Med. 2012;156(11):817–33.

    PubMed  PubMed Central  Google Scholar 

  18. Mizuno Y, Higa DH, Leighton CA, Roland KB, Deluca JB, Koenig LJ. Is HIV patient navigation associated with HIV care continuum outcomes? AIDS (London, England). 2018;32(17):2557–71.

    Google Scholar 

  19. Bryant FB, Yarnold PR. Principal-components analysis and exploratory and confirmatory factor analysis. In: Grimm LG, Yarnold PR, editors. Reading and understanding multivariate statistics. Washington, DC: American Psychological Association; 1995. p. 99–136.

    Google Scholar 

  20. SPSS for Windows [computer program]. 2020. Version 21. Amonk, NY.

  21. 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.

    CAS  PubMed  Google Scholar 

  22. Jordan AO, Cohen LR, Harriman G, Teixeira PA, Cruzado-Quinones J, Venters H. Transitional care coordination in New York City jails: facilitating linkages to care for people with HIV returning home from Rikers Island. AIDS Behav. 2013;17(Suppl. 2):S212-219.

    PubMed  Google Scholar 

  23. Koester KA, Morewitz M, Pearson 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.

    PubMed  PubMed Central  Google Scholar 

  24. Myers JJ, Koester KA, Kang Dufour MS, Jordan AO, Cruzado-Quinone J, Riker A. Patient navigators effectively support HIV-infected individuals returning to the community from jail settings. Int J Prison Health. 2017;13(3–4):213–8.

    PubMed  Google Scholar 

  25. Stitzer M, Matheson T, Cunningham C, et al. Enhancing patient navigation to improve intervention session attendance and viral load suppression of persons with HIV and substance use: a secondary post hoc analysis of the Project HOPE study. Addict Sci Clin Pract. 2017;12(1):16.

    PubMed  PubMed Central  Google Scholar 

  26. Andersen M, Hockman E, Smereck G, et al. Retaining women in HIV medical care. JANAC J Assoc Nurses AIDS Care. 2007;18(3):33–41.

    PubMed  Google Scholar 

  27. Andersen M, Paliwoda J, Kaczynski R, et al. Integrating medical and substance abuse treatment for addicts living with HIV/AIDS: evidence-based nursing practice model. Am J Drug Alcohol Abuse. 2003;29(4):847–59.

    PubMed  Google Scholar 

  28. Asamsama OH, Squires L, Tessema A, et al. HIV nurse navigation: charting the course to improve engagement in care and HIV virologic suppression. J Int Assoc Provid AIDS Care. 2017;16(6):603–7.

    Google Scholar 

  29. Bove JM, Golden MR, Dhanireddy S, Harrington RD, Dombrowski JC. Outcomes of a clinic-based surveillance-informed intervention to relink patients to HIV care. JAIDS J Acquir Immune Defic Syndr. 2015;70(3):262–8.

    PubMed  Google Scholar 

  30. Cabral HJ, Davis-Plourde K, Sarango M, Fox J, Palmisano J, Rajabiun S. 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. 2018;22(8):2627–39.

    PubMed  Google Scholar 

  31. Cabral HJ, Tobias C, Rajabiun S, et al. Outreach program contacts: do they increase the likelihood of engagement and retention in HIV primary care for hard-to-reach patients? AIDS Patient Care STDS. 2007;21(Suppl. 1):S59–67.

    PubMed  Google Scholar 

  32. Cunningham WE, Weiss RE, Nakazono T, et al. Effectiveness of a peer navigation intervention to sustain viral suppression among HIV-positive men and transgender women released from jail: the LINK LA randomized clinical trial. JAMA Intern Med. 2018;178(4):542–53.

    PubMed  PubMed Central  Google Scholar 

  33. 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 (London, England). 2005;19(4):423–31.

    Google Scholar 

  34. Irvine MK, Chamberlin SA, Robbins RS, Kulkarni SG, Robertson MM, Nash D. Come as you are: improving care engagement and viral load suppression among HIV care coordination clients with lower mental health functioning, unstable housing, and hard drug use. AIDS Behav. 2017;21(6):1572–9.

    PubMed  PubMed Central  Google Scholar 

  35. Keller J, Heine A, LeViere AF, et al. HIV patient retention: the implementation of a North Carolina clinic-based protocol. AIDS Care. 2017;29(5):627–31.

    PubMed  Google Scholar 

  36. Kral AH, Lambdin BH, Comfort M, et al. A strengths-based case management intervention to reduce HIV viral load among people who use drugs. AIDS Behav. 2018;22(1):146–53.

    PubMed  Google Scholar 

  37. Leider J, Fettig J, Calderon Y. Engaging HIV-positive individuals in specialized care from an urban emergency department. AIDS Patient Care STDS. 2011;25(2):89–93.

    PubMed  PubMed Central  Google Scholar 

  38. Maulsby C, Charles V, Kinsky S, Riordan M, Jain K, Holtgrave D. Positive charge: filling the gaps in the U.S. HIV continuum of care. AIDS Behav. 2015;19(11):2097–107.

    PubMed  Google Scholar 

  39. Metsch LR, Feaster DJ, Gooden L, et al. Effect of patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use: a randomized clinical trial. JAMA J Am Med Assoc. 2016;316(2):156–70.

    Google Scholar 

  40. Mignano JL, Miner L, Siedl K, et al. Results and implications of routine HIV testing in the inpatient setting: a descriptive analysis. Popul Health Manag. 2018;21(1):40–5.

    PubMed  Google Scholar 

  41. Molitor F, Waltermeyer J, Mendoza M, et al. Locating and linking to medical care HIV-positive persons without a history of care: findings from the California Bridge Project. AIDS Care. 2006;18(5):456–9.

    CAS  PubMed  Google Scholar 

  42. Myers JJ, Kang Dufour MS, Koester KA, et al. The effect of patient navigation on the likelihood of engagement in clinical care for HIV-infected individuals leaving jail. Am J Public Health. 2018;108(3):385–92.

    PubMed  PubMed Central  Google Scholar 

  43. Rich JD, Holmes L, Salas C, et al. Successful linkage of medical care and community services for HIV-positive offenders being released from prison. J Urban Health. 2001;78(2):279–89.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Shacham E, López JD, Brown TM, Tippit K, Ritz A. Enhancing adherence to care in the HIV care continuum: the barrier elimination and care navigation (BEACON) project evaluation. AIDS Behav. 2018;22(1):258–64.

    PubMed  Google Scholar 

  45. Sitapati AM, Limneos J, Bonet-Vázquez M, Mar-Tang M, Qin H, Mathews WC. Retention: building a patient-centered medical home in HIV primary care through PUFF (Patients Unable to Follow-up Found). J Health Care Poor Underserved. 2012;23(3 Suppl.):81–95.

    PubMed  Google Scholar 

  46. Teixeira PA, Jordan AO, Zaller N, Shah D, Venters H. Health outcomes for HIV-infected persons released from the New York City jail system with a transitional care-coordination plan. Am J Public Health. 2015;105(2):351–7.

    PubMed  PubMed Central  Google Scholar 

  47. Wohl AR, Dierst-Davies R, Victoroff A, et al. Implementation and operational research: the navigation program: an intervention to reengage lost patients at 7 HIV clinics in Los Angeles County, 2012–2014. JAIDS J Acquir Immune Defic Syndr. 2016;71(2):e44–50.

    PubMed  Google Scholar 

  48. Wohl AR, Ludwig-Barron N, Dierst-Davies R, et al. Project engage: snowball sampling and direct recruitment to identify and link hard-to-reach HIV-infected persons who are out of care. JAIDS J Acquir Immune Defic Syndr. 2017;75(2):190–7.

    PubMed  Google Scholar 

  49. Watkins M. Psychosocial accompaniment. J Soc Polit Psychol. 2015;3(1):324–41.

    Google Scholar 

  50. Farmer P. Accompaniment as policy [transcript of speech]. 2011. https://www.lessonsfromhaiti.org/press-and-media/transcripts/accompaniment-as-policy/. Accessed 22 May 2020.

  51. Farmer P. To repair the world: Paul Farmer speaks to the next generation. Oakland: University of California Press; 2013.

    Google Scholar 

  52. Roland KB, Higa DH, Leighton CA, Mizuno Y, DeLuca JB, Koenig LJ. Client perspectives and experiences with HIV patient navigation in the united states: a qualitative meta-synthesis. Health Promot Pract. 2020;21(1):25–36.

    PubMed  Google Scholar 

  53. Roland KB, Higa DH, Leighton CA, Mizuno Y, DeLuca JB, Koenig LJ. HIV patient navigation in the United States: a qualitative meta-synthesis of navigators’ experiences. Health Promot Pract. 2020. https://doi.org/10.1177/1524839920982603

    Article  PubMed  Google Scholar 

  54. Fanfair RN, Khalil G, Camp N, et al. Health department randomized trial to re-engage out-of-care HIV infected persons—The Cooperative Re-engagement Controlled Trial. 2019. Conference on Retroviruses and Opportunistic Infections. Seattle, Washington

  55. Sweeney P, DiNenno EA, Flores SA, et al. HIV data to care-using public health data to improve HIV care and prevention. JAIDS J Acquir Immune Defic Syndr. 2019;82(Suppl. 1):S1–5.

    PubMed  Google Scholar 

  56. Giacamazzo A, Challacombe L. Health navigation in HIV services: A review of the evidence. CATIE: Canadian AIDS Treatment and Information Exchange. 2018. https://www.catie.ca/en/pif/fall-2018/health-navigation-hiv-services-review-evidence. Accessed 26 May 2020.

  57. Bowen EA, Canfield J, Moore S, Hines M, Hartke B, Rademacher C. Predictors of CD4 health and viral suppression outcomes for formerly homeless people living with HIV/AIDS in scattered site supportive housing. AIDS Care. 2017;29(11):1458–62.

    PubMed  Google Scholar 

  58. Maskay MH, Cabral HJ, Davila JA, et al. Longitudinal stigma reduction in people living with HIV experiencing homelessness or unstable housing diagnosed with mental health or substance use disorders: an intervention study. Am J Public Health. 2018;108(Suppl. 7):S546–51.

    PubMed  PubMed Central  Google Scholar 

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Contributions

LJK: conceptualized the review, oversaw the intervention abstraction and prepared the original draft; DHH: conducted the statistical analyses; JBD: conducted the literature review; LJK, DHH, CAL, KBR and YM: coded studies; all authors edited the paper and revised it critically for important intellectual contributions.

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Correspondence to Linda J. Koenig.

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Koenig, L.J., Higa, D.H., Leighton, C.A. et al. Toward An Enhanced Understanding of HIV Patient Navigation as a Health Care Intervention: An Analysis of Navigation in Practice. AIDS Behav 25, 4044–4054 (2021). https://doi.org/10.1007/s10461-021-03244-6

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Keywords

  • Patient navigation
  • Care coordination
  • Health care navigation
  • HIV
  • AIDS