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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

Maxine Stitzer; Tim Matheson; Colin Cunningham; James L. Sorensen; Daniel J. Feaster; Lauren K. Gooden; Alexis S. Hammond; Heather Fitzsimons; Lisa Metsch

Title:
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
Author(s):
Stitzer, Maxine
Matheson, Tim
Cunningham, Colin
Sorensen, James L.
Feaster, Daniel J.
Gooden, Lauren K.
Hammond, Alexis S.
Fitzsimons, Heather
Metsch, Lisa
Date:
Type:
Articles
Department(s):
Sociomedical Sciences
Volume:
12
Persistent URL:
Book/Journal Title:
Addiction Science & Clinical Practice
Notes:
Keywords: HIV health care, HIV substance users, Patient navigation, Contingent incentives, Session attendance, Vial suppression
Abstract:
Background: Interventions are needed to improve viral suppression rates among persons with HIV and substance use. A 3-arm randomized multi-site study (Metsch et al. in JAMA 316:156–70, 2016) was conducted to evaluate the effect on HIV outcomes of usual care referral to HIV and substance use services (N = 253) versus patient navigation delivered alone (PN: N = 266) or together with contingency management (PN + CM; N = 271) that provided financial incentives targeting potential behavioral mediators of viral load suppression. Aims: This secondary analysis evaluates the effects of financial incentives on attendance at PN sessions and the relationship between session attendance and viral load suppression at end of the intervention. Methods: Frequency of sessions attended was analyzed over time and by distribution of individual session attendance frequency (PN vs PN + CM). Percent virally suppressed (≤200 copies/mL) at 6 months was compared for low, medium and high rate attenders. In PN + CM a total of $220 could be earned for attendance at 11 PN sessions over the 6-month intervention with payments ranging from $10 to $30 under an escalating schedule. Results: The majority (74%) of PN-only participants attended 6 or more sessions but only 28% attended 10 or more and 16% attended all eleven sessions. In contrast, 90% of PN + CM attended 6 or more visits, 69% attended 10 or more and 57% attended all eleven sessions (attendance distribution χ2[11] = 105.81; p < .0001). Overall (PN and PN + CM participants combined) percent with viral load suppression at 6-months was 15, 38 and 54% among those who attended 0–5, 6–9 and 10–11 visits, respectively (χ2(2) = 39.07, p < .001). Conclusion: In this secondary post hoc analysis, contact with patient navigators was increased by attendance incentives. Higher rates of attendance at patient navigation sessions was associated with viral suppression at the 6-month follow-up assessment. Study results support use of attendance incentives to improve rates of contact between service providers and patients, particularly patients who are difficult to engage in care. Trial Registration clinicaltrials.govIdentifier: NCT01612169.
Subject(s):
HIV (Viruses)--Patients
Medical care
Behavioral assessment
Substance abuse--Patients--Counseling of
HIV-positive persons--Services for
Incentive (Psychology)
Social medicine
Publisher DOI:
https://doi.org/10.1186/s13722-017-0081-1
Item views
23
Metadata:
text | xml
Suggested Citation:
Maxine Stitzer, Tim Matheson, Colin Cunningham, James L. Sorensen, Daniel J. Feaster, Lauren K. Gooden, Alexis S. Hammond, Heather Fitzsimons, Lisa Metsch, , 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, Columbia University Academic Commons, .

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