<i class="fa fa-comments-o"> </i> Patient Navigation
Enhanced Patient Navigation for HIV-Positive Women of Color
The Enhanced Patient Navigation for HIV-Positive Women of Color intervention is designed to retain HIV-positive Women of Color (WoC) in HIV primary care after receiving support, education, and coaching from a patient navigator. Patient navigators are critical members of the health care team focused on reducing barriers to care for the patient at the individual, agency, and system levels. While engaging with patients, patient navigators lend emotional, practical, and social support; provide education on topics related to living with HIV and navigating the health care system; and support both patients and the health care team in coordinating services. In this intervention, patient navigators will work with HIV-positive WoC who are experiencing at least one of the following challenges: have fallen out of care for 6 months or more, have missed 2 or more appointments in the prior 6 months, are loosely engaged in care (have cancelled or missed appointments),1 are not virally suppressed, and/or have multiple co-morbidities.
This intervention is intended for organizations, agencies, and clinics considering integrating a structured patient-navigation model to increase retention of HIV-positive WoC to ultimately improve health outcomes.
Reaching, linking, and retaining people living with HIV (PLWH), including Women of Color (WoC) in health care, are federal priorities and are integral steps of the HIV Care Continuum due to their importance in increasing viral load suppression (the main goal of HIV treatment and a key factor in prevention). Pecoraro et al. found, "patients dropped out of care because of multiple factors such as substance abuse, unstable housing, psychiatric disorders, incarceration, side-effects from HIV medication, denial about diagnosis, relocation, stigma, forgetfulness, and problems with the patient's medical home."2 Higa et al. found, "Patients retained in care have decreased likelihood of developing HIV opportunistic infections, greater viral load suppression, and increased survival rates [and] poor retention is associated with higher viral loads and lower CD4 counts increased HIV risk behavior, and more hospitalizations."3 According to Higa et al., lower retention in HIV care is associated with client-level factors including:
A theory is a combination of, "interrelated concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations amount variables, in order to explain or predict the events or situations."25 By grounding an intervention in theory, the component parts are intentionally sequenced to build off of one another to facilitate a change in health behavior.
Intervention Components and Activities
This Enhanced Patient Navigation for HIV-Positive Women of Color intervention targets HIV-positive WoC 18 years and older who meet the following criteria: have not been seen at the clinic in the prior 6 months; have missed 2 or more appointments in the prior 6 months; are loosely engaged in care (have cancelled or missed appointments in the prior 12 months); are not virally suppressed; and/or have multiple co-morbidities. The intervention focuses on providing enhanced services in addition to the clinic's existing case management standard of care and support to patients, building patient trust, meeting patient priorities first (putting the patients priorities ahead of service provider priorities), increasing patient health literacy, strengthening patient health beliefs, and developing patient self-efficacy in managing their care. Services are tailored to the individual patient and typically include appointment scheduling, transportation, accompaniment, referrals, health education, and counseling. The goal of the Enhanced Patient Navigation for HIV-Positive Women of Color intervention is to better understand patient needs, help patients to optimize care, to ultimately develop patient autonomy for their care and to retain patients in HIV primary care.
The following staff positions need to be developed and filled in order to successfully implement the intervention.
The following are programmatic requirements that need to be addressed prior to implementation in order to facilitate a successful implementation:
Estimated costs for navigation-like interventions with the goal of linking HIV patients to care ranged from $97 to $536 per month per patient from a provider perspective and $44 to $545 per month per patient from a societal perspective.30 For interventions with the goal of retention in care the cost per patient per year ranged from $207 to $531 from a provider perspective.31 These interventions used a variety of approaches including peer/patient navigation, motivational interviewing, community health workers, and care coordination.
Overview of prior SPNS initiatives
- Targeted HIV Outreach and Intervention Models for Underserved HIV-positive Populations Not In Care.
- The Costs and Effects of Outreach Strategies that Engage and Retain People with HIV/AIDS in Primary Care.
- Outreach: Engaging People in HIV Care: Summary of a HRSA/HAB 2005 Consultation on Linking PLWH into Care.
The following source documents were cited in the Intervention document: