Convenience sample.
Recruitment and enrollment for this demonstration project lasted approximately 18 months. Subjects completed follow-up assessment at 3 and 6 months post-intervention.
Approximately 336 subjects.
Eligible subjects included HIV-infected individuals 18-years or older found to be out-of-care. Out-of-care is defined as: no HIV primary care visits in the previous 6-12 months and last viral load test was greater than 200 copies/ml; OR no HIV primary care visits in more than 12 months; OR newly-diagnosed and never in care; OR <2 HIV primary care visits at the same HIV care provider in the previous 6 months; OR recently released from jail, prison or other institution and no regular HIV care provider; OR in intermittent or inadequate care as determined by the Principal Investigator
A screening instrument was administered to determine a patient's level of readiness to engage in care and used to determine the intensity of the intervention administered. Three interventions available include: 1) a low-intensity linkage to care intervention; 2) a medium-intensity one session motivational interviewing intervention, and 3) a high-intensity modified ARTAS multi-session (up to 10 visits in a 3 month period) intervention.
Tier 1 Intervention-low intensity: In the low-intensity linkage to care intervention patients met with the navigator at the clinic to discuss their care options, scheduled an HIV clinic appointment and received assistance with overcoming any structural barriers that may be related to receiving care (streamlining financial screening, appointment scheduling, administrative hurdles, obtaining paperwork such as identification, etc…). This intervention was intended for individuals who are motivated to obtain care but need some assistance navigation the process.
Tier 2 Intervention-medium intensity: In this medium-intensity one-two session Motivational Interviewing (MI) intervention navigators met with clients for up to 90 minutes at a location of their choosing to specifically explore their ambivalence about obtaining care. At the end of this intervention clients should be ready to link to care with the help of the navigator, who worked with clients to on a linkage to care plan (which should include selection of a clinic, an identified appointment date/time and transportation and identifying structural barriers that must be overcome.
Tier 3 Intervention-high intensity: The this high-intensity modified ARTAS multi-session intervention (up to 10 sessions over 90 days) sessions focused on building trust and rapport, assess readiness and barriers to engaging in care, clarify an action plan and transition subjects in to care. Each session can be up to 90 minutes long and took place at a mutually agreed upon location.
If a client fails to link to care in either of the first or second tier intervention then they were automatically enrolled into the next level intensity intervention until they have reached Tier 3. Once linked, clients entered a transitional retention phase where navigators continued to work with clinic staff for 6 months to ensure that the patient was attending all necessary medical appointments and receiving appropriate ancillary support.
To evaluate if the use of navigators is effective at finding and retaining lost to care HIV patients.
To evaluate if a tiered intervention strategy is an efficient way of linking clients to care.
If the use of patient navigators is successful at retaining these clients in care by offering additional support services