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Dwyer L, Rajai A, Dowding D, Kearney R. Understanding Factors That Affect Willingness to Self-Manage a Pessary for Pelvic Organ Prolapse: A Questionnaire-Based Cross-Sectional Study of Pessary-Using Women in the UK. Int Urogynecol J 2024:10.1007/s00192-024-05840-1. [PMID: 38953998 DOI: 10.1007/s00192-024-05840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/25/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Pessary self-management offers benefits to women with no increased risk of complications. However, many are unwilling to self-manage, preferring clinician-led care. This study is aimed at exploring factors associated with willingness to self-manage a pessary. METHODS Women attending pessary clinic at a UK hospital were asked to complete a questionnaire providing responses on pessary use, comorbidities, female genital self-image, self-management experience and willingness (or not) to learn self-management. Based upon statistical advice we aimed to recruit 90 women. Data were analysed using the non-parametric Kruskal-Wallis test and Chi-squared test. Free text data were analysed thematically. RESULTS A total of 89 women completed the questionnaire. Thirty-three women (38%) had previously been taught pessary self-management. Of the remaining women, 12 (21%) were willing to learn, 28 (50%) were not willing and 16 (29%) were unsure. There was no correlation between female genital self-image and willingness to self-manage a pessary. Younger women were more willing to learn self-management (p = < 0.001). Willing women were motivated by reduced follow-up visits. Self-managing women reported benefits including increased autonomy, cleanliness and giving their body "a break". Reasons discouraging women from self-managing were a lack of confidence; feeling physically unable; wanting clinician-led care; fear of problems or previous problems with their pessary. CONCLUSIONS Most women were either unsure about pessary self-management or unwilling to self-manage. Age was the only factor we found that had a significant relationship with willingness to self-manage a pessary. With robust self-management teaching, support and follow-up, it is likely that many of the barriers women report can be overcome.
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Affiliation(s)
- Lucy Dwyer
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Hathersage Road, Manchester, M13 9WL, UK.
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
- The Warrell Unit, Saint Mary's Hospital, Manchester University NHS Foundation Trust, Hathersage Road, Manchester, M13 9WL, UK.
| | - Azita Rajai
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Hathersage Road, Manchester, M13 9WL, UK
- Centre for Biostatistics, Division of Population Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Rohna Kearney
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Hathersage Road, Manchester, M13 9WL, UK
- Institute of Human Development, Faculty of Medical & Human Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Hassan KS, Coon DW. The Provider's Role in Retaining Black Women With HIV in Care: A Scoping Review. J Int Assoc Provid AIDS Care 2024; 23:23259582231224232. [PMID: 38225200 DOI: 10.1177/23259582231224232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Black/African American women represent 54% of new HIV cases among all women in the United States, face higher rates of morbidity and mortality, and are often understudied. The patient-provider relationship is an important motivator to keeping people who live with HIV retained in care and adherent to a medical regimen, thereby improving chances for viral suppression and maintaining overall better health. This scoping review sought to determine the extent of documented provider actions that encourage Black women with HIV to stay engaged in care. The review investigated five databases for peer-reviewed studies in the United States that included Black women from 2009 to 2023 and specifically described beneficial provider actions or behaviors. Of 526 records, 12 met the criteria. Studies revealed that women are motivated by providers who create a respectful, nonjudgmental emotionally supportive relationship with them rather than those who rely on an authoritative transactional exchange of information and orders.
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Affiliation(s)
- Kenja S Hassan
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - David W Coon
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
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3
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Davis DA, Muessig KE, Matthews DD, Angeles G, McNaughton-Reyes L, Guzmán K, Northbrook S, Barrington C. 'She showed me a new path, a way forward': exploring how navigation influences mental health among Guatemalan gay and bisexual men living with HIV. Health Promot Int 2023; 38:daab188. [PMID: 34849870 PMCID: PMC9233178 DOI: 10.1093/heapro/daab188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Mental health problems, including anxiety and depression, are a common comorbidity among gay, bisexual and other men who have sex with men (GBMSM) living with HIV. Informed by social support theory, health navigation is a strengths-based intervention that has been demonstrated to improve HIV care outcomes. The purpose of this study was to explore how health navigation influences the mental health of GBMSM living with HIV. We analyzed longitudinal qualitative in-depth interviews conducted with GBMSM (n = 29) in a 12-month multi-component intervention to improve HIV care outcomes, including health navigation. We used narrative and thematic analytic approaches to identify salient themes, including if and how themes changed over time. Participants described that navigator support helped them maintain good mental health, prevent crises and respond to crises. Navigator support included providing motivational messaging, facilitating participants' control over their health and improving access to care, which aided with supporting mental health. Navigators also responded to acute crises by providing guidance for those newly diagnosed with HIV and support for those experiencing critical life events. Participants emphasized the importance of feeling heard and valued by their navigators and gaining hope for the future as key to their wellbeing. In conclusion, health navigation may be an effective intervention for promoting mental health among GBMSM living with HIV. Additional research is needed to examine mediating pathways between navigation and mental health, including informational support, or if navigator support moderates the relationship between stressors and mental health outcomes for GBMSM.
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Affiliation(s)
- Dirk A Davis
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Gustavo Angeles
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Luz McNaughton-Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
| | - Karla Guzmán
- HIV Central America Regional Program, Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11-95, Zona 15, Vista Hermosa III, Guatemala City, Guatemala
| | - Sanny Northbrook
- US Center for Disease Control and Prevention (CDC) Central America Region, 11 calle 15-79, Zona 15, Vista Hermosa III, Guatemala City, Guatemala
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive Chapel Hill, NC 27599-7400, USA
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4
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Conteh NK, Latona A, Mahomed O. Mapping the effectiveness of integrating mental health in HIV programs: a scoping review. BMC Health Serv Res 2023; 23:396. [PMID: 37095471 PMCID: PMC10127013 DOI: 10.1186/s12913-023-09359-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Mental health and substance abuse issues are increasing among HIV-positive people, and it negatively impacts health outcomes like engagement, retention in HIV care, and adherence to ART. Thus, national ART programs must include mental health management. The scoping review sought to map evidence on the efficacy of combining HIV and mental health care. METHODS The Arksey and O'Malley methodological framework was used to map the existing research on integrating HIV and mental health services to identify knowledge gaps. Two independent reviewers screened articles for inclusion. Studies on HIV-mental health integration were considered. We searched numerous sources, extracted data, and summarized publications by integration model and patient outcomes. RESULTS Twenty-nine articles met the criteria for this scoping review. Twenty-three studies were from high-income countries, with only six from low and middle-income countries in Africa (Zimbabwe 1, Uganda 3, South Africa 1, and Tanzania 1). Most of the literature discussed single-facility integration although multi-facility and integrated care through a case manager was researched as well. There was a reduction in depression, alcohol use, increased social function, decreased self-reported stigma, decreased psychiatric symptoms, and improved mood in PLHIV who received cognitive behavioral therapy in settings implementing integrated care. When providing integrated mental health services to PLHIV, healthcare workers reported feeling more comfortable discussing mental illness. Personnel in the mental health field reported less stigma and increased PLHIV referrals for mental health services due to integrated HIV and mental health care. CONCLUSION According to the research, integrating mental health services into HIV care improves the diagnosis and treatment of depression and other mental disorders related to substance abuse in PLHIV.
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Medeiros P, Gupta M, Wong H, Kazemi M, Ndung'u M, Smith S, Kishibe T, Loutfy M. Women-centred HIV care: a scoping review to understand the current state of service delivery for women living with HIV globally. AIDS Care 2022; 34:1083-1093. [PMID: 34260327 DOI: 10.1080/09540121.2021.1948498] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Women living with HIV (WLWH) face unique barriers and require specialized, integrated care that focuses on women's specific needs. We conducted a scoping review to examine factors important for a women-centred HIV care (WCHC) approach. We included published peer-reviewed articles which featured WCHC services as their central focus; included study populations of girls and WLWH aged 14 years of age or older; and contributed to the understanding of WCHC for WLWH. Seven databases were reviewed and yielded 15,332 references, of which 21 fit our inclusion criteria for the scoping review. Research findings were categorized into characteristics of the study, recommendations, and target audiences. Findings revealed WCHC as care which includes the involvement of WLWH in decisions; person-centred integrated care; integrated services including mental health; sexual and reproductive health services; trauma-informed and safe space practices; healthcare provider training; and women's care self-management. In general, current systems of care do not meet the unique needs of WLWH.
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Affiliation(s)
- Priscilla Medeiros
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,CIHR Canadian HIV Trials Network, Vancouver, Canada
| | - Meenakshi Gupta
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Heather Wong
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Mary Ndung'u
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Stephanie Smith
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | | | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Library Services, Unity Health Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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Khalpey Z, Fitzgerald L, Howard C, Istiko SN, Dean J, Mutch A. Peer navigators' role in supporting people living with human immunodeficiency virus in Australia: Qualitative exploration of general practitioners' perspectives. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1353-1362. [PMID: 34101291 DOI: 10.1111/hsc.13465] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/11/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
The redefining of human immunodeficiency virus (HIV) from an acute disease to a manageable chronic illness has reshaped the focus of care, emphasising clinical outcomes and sidelining the complex social barriers many people living with HIV (PLHIV) still face. This parallels changes in the location of HIV care in Australia, with many PLHIV seeking care from private general practitioners whose ability to address complex social issues is constrained by limitations of time and resources. In response, peer navigation has emerged as a model of care implemented by some HIV-based community health organisations seeking to support PLHIV's biomedical and psychosocial needs. However, there is limited understanding of how peer navigation operates in community settings or of the way these programmes integrate with primary care. This paper is the first to explore peer navigation from the perspective of general practitioners (GPs), with experience in treating PLHIV, to understand the role they see for peer navigators (PNs) in supporting PLHIV. Semi-structured in-depth interviews were conducted with six GPs (11.5% of specialty HIV GPs in Queensland, Australia) to examine their views and experiences of peer navigation in the context of HIV care. GPs highlighted the complexities of care for PLHIV and the need for additional resources and supports for psychosocial care. GPs valued peer navigation as part of a patient support network and bridge to health and social care systems. PNs normalised HIV, alleviating fear and stigma, educating and translating clinical information for patients. However, a key challenge was the absence of direct communication pathways with PNs. Peer navigation has clear potential in supporting the care of PLHIV, to alleviate constraints in GP settings and expand HIV care beyond the clinic.
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Affiliation(s)
- Zoyah Khalpey
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Chris Howard
- Queensland Positive People (QPP), Brisbane, Queensland, Australia
| | - Satrio Nindyo Istiko
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Judith Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Allyson Mutch
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Wilkinson A, Atlas J, Nelson K, Mulligan H. Client perceptions of engaging with a health and social care navigation service: A qualitative study. Chronic Illn 2022; 18:169-180. [PMID: 32727202 DOI: 10.1177/1742395320937046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Health and social care navigation services provide support for people with long-term conditions. Such services are available in the New Zealand (NZ) context. However little is known nationally or internationally about clients' experience of engaging with such services. This study aimed to describe client perspectives of engaging with a health and social care navigation service in a NZ metropolitan city. METHODS The manager and navigators of the service recruited clients who were previous users of the service. We individually interviewed nine clients (F = 7; M = 2; aged between 30-80 years) in their homes. Many of the participants reported social isolation, and some were without regular income. We transcribed interviews verbatim and analysed data thematically. RESULTS There was one overall theme: Restoration of my essence or being (in the Māori language, wairua), and sense of belonging (turangawaewae) through a regenerative approach developed in partnership between the navigator and the client. Thus, participants felt renewed and validated as human beings. DISCUSSION Enabling clients to feel re-valued as human beings captures the concept of personhood whereby a person has capability and capacity for life choices. We suggest enabling a client to feel valued assists in development of self-determination and consequently improved health and well-being.
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Affiliation(s)
- Amanda Wilkinson
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Janel Atlas
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Katrina Nelson
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hilda Mulligan
- Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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8
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Greene GJ, Reidy E, Felt D, Marro R, Johnson AK, Phillips G, Green E, Stonehouse P. Implementation and evaluation of patient navigation in Chicago: Insights on addressing the social determinants of health and integrating HIV prevention and care services. EVALUATION AND PROGRAM PLANNING 2022; 90:101977. [PMID: 34373116 DOI: 10.1016/j.evalprogplan.2021.101977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/12/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
Patient navigation is a primary element in linkage to HIV pre-exposure prophylaxis (PrEP) care and linkage to or re-engagement in HIV care, depending on the HIV status of the individual. However, there is a dearth of literature describing navigation services in these areas. In the context of Chicago Project PrIDE, this project conducted process and implementation evaluations with eight agencies leading demonstration projects to address these gaps. The evaluation team conducted semi-structured, individual interviews with agency staff (N = 20) assessing navigation implementation and fit, as well as project successes and challenges. Additionally, agency staff collected patient surveys (N = 300) assessing services provided, service quality, and satisfaction. The interview transcripts were coded and analyzed thematically and descriptive analyses were performed on the survey data. Analyses indicated that screening for social determinants of health, providing healthcare engagement guidance, and providing service referrals were frequently cited navigation activities. Most staff members indicated that navigation fits well within their agencies, and that limited staff and clinic capacity were often barriers to navigation. Patient navigation to support engagement in HIV prevention and care services is critical due to the extensive support provided by navigators to address social determinants of health impacting HIV disparity populations.
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Affiliation(s)
- George J Greene
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA.
| | - Emma Reidy
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Dylan Felt
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Rachel Marro
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Amy K Johnson
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, The Potocsnak Family Division of Adolescent and Young Adult Medicine, 225 E. Chicago Ave., Box 161, Chicago, IL, 60611, USA
| | - Gregory Phillips
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Evelyn Green
- Chicago Department of Public Health, 333 S. State St., Suite 200, Chicago, IL, 60604, USA
| | - Patrick Stonehouse
- Chicago Department of Public Health, 333 S. State St., Suite 200, Chicago, IL, 60604, USA
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9
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Davoust M, Drainoni ML, Baughman A, Campos Rojo M, Estes T, Rajabiun S, Ross-Davis K, McCann K, Sullivan M, Todd L, Wolfe HL, Sprague Martinez L. "He Gave Me Spirit and Hope": Client Experiences with the Implementation of Community Health Worker Programs in HIV Care. AIDS Patient Care STDS 2021; 35:318-326. [PMID: 34375140 DOI: 10.1089/apc.2021.0085] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Community health workers (CHWs) are members of the frontline health workforce who serve as intermediaries between health services and communities. In the United States, the role of CHWs has begun to expand as they have been shown to improve outcomes and reduce inequities in care for chronic conditions. This study used qualitative methods to explore the experiences of clients in CHW programs to inform their implementation in HIV care. Thirty clients from 6 Ryan White HIV/AIDS Program care settings across the United States participated in individual semistructured interviews to learn more about their experiences working with a CHW. Four key themes arose from the client perspective. First, CHWs embodied key qualities. Some of the qualities clients attributed to CHWs included being caring and supportive, along with capable of fostering personal connections. Second, CHWs met clients where they were. Clients described the CHW approach as more holistic compared with other care team members; they emphasized CHWs were able to focus on whatever was needed in that moment. Third, CHWs occupied a unique role in the HIV care team. Clients noted CHWs had more time to dedicate to their interactions; they also saw CHWs as representing a different level of authority. Finally, CHWs influenced how clients engaged with care and accessed resources. This included empowering clients to access resources independently in the future. Overall, clients' perceptions of CHWs in terms of their qualities, approach, role, and influence on the HIV care experience suggest they are a valuable resource on the care team.
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Affiliation(s)
- Melissa Davoust
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Allyson Baughman
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Maria Campos Rojo
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Terry Estes
- Southwest Louisiana AIDS Council, Lake Charles, Louisiana, USA
| | - Serena Rajabiun
- Department of Public Health, University of Massachusetts—Lowell, Lowell, Massachusetts, USA
| | - Kelly Ross-Davis
- 1917 Clinic at the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katherine McCann
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - Marena Sullivan
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
| | - LaWanda Todd
- Division of Infectious Diseases and International Travel Health, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Hill L. Wolfe
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Linda Sprague Martinez
- Center for Innovation in Social Work and Health, School of Social Work, Boston University, Boston, Massachusetts, USA
- Macro Department, Boston University School of Social Work, Boston, Massachusetts, USA
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10
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Kokorelias KM, Shiers-Hanley JE, Rios J, Knoepfli A, Hitzig SL. Factors Influencing the Implementation of Patient Navigation Programs for Adults with Complex Needs: A Scoping Review of the Literature. Health Serv Insights 2021; 14:11786329211033267. [PMID: 34349519 PMCID: PMC8287353 DOI: 10.1177/11786329211033267] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
Patient navigation is a model of care that aims to improve access to care by reducing the complexity of navigating health, education, and social services across the continuum of care and care settings. Little is known about the processes that facilitate or impede the implementation of patient navigation programs (PNPs). We conducted a scoping review to identify and summarize the current state of knowledge regarding the implementation and outcomes of existing implemented PNPs. We employed a 6-stage scoping review framework to identify and review eligible articles. Sixty-articles met the inclusion criteria (58 peer-reviewed and 2 grey literature). The Consolidated Framework for Implementation Research served as the theoretical framework during analysis to help extract factors relevant to implementation of navigator programs. Results of the scoping review are reported thematically. Influences on implementation were identified: (a) planning to ensure alignment with organizational need (b) funding (c) multidisciplinary engagement (d) establishing workflow (e) mechanisms for communication (f) stakeholders to encourage buy-in (g) appropriate caseload (h) in kind resources. PNPs improve the experiences of patients and families. The findings of this scoping review provides implementation considerations of PNPs across global care settings. Strategies for overcoming pragmatic and logistical issues must be developed for optimal implementation.
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Affiliation(s)
- Kristina M Kokorelias
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
| | - Jessica E Shiers-Hanley
- Hazel McCallion Academic Learning
Centre, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science
& Occupational Therapy, Temerty Faculty of Medicine, University of Toronto
| | - Jorge Rios
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
| | - Amanda Knoepfli
- Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
- SPRINT Senior Care, Toronto, ON,
Canada
| | - Sander L Hitzig
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
- Department of Occupational Science
& Occupational Therapy, Temerty Faculty of Medicine, University of Toronto
- Rehabilitation Sciences Institute,
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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11
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Barr E, Dubé K, Swaminathan S, Del Rio C, Campbell DM, Paez-Quinde M, Cohn SE. Impact of dedicated women's outreach workers (WOWs) on recruitment of women in ACTG clinical studies. HIV Res Clin Pract 2021; 22:37-45. [PMID: 34143949 DOI: 10.1080/25787489.2021.1938825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite efforts by the AIDS Clinical Trials Group (ACTG) to enroll representative numbers of diverse women, participation in ACTG studies in the United States remains largely white and male. To address this gap in women's participation in ACTG research, a one-year pilot study of dedicated women's outreach workers (WOWs) was proposed. OBJECTIVES included demonstrating that targeted recruitment efforts can expand community awareness of ACTG research and ensuring successful enrollment of women at the respective clinical research sites. METHODS The pilot study was conducted at two U.S. sites (Rutgers New Jersey Medical School and Emory Ponce de Leon Center in Atlanta, Georgia). The WOWs worked with site personnel to identify and reach out to women living with HIV and/or Hepatitis B or C at their respective sites and encourage them to join a clinical trial registry for those interested in participating in future clinical trials. RESULTS The Rutgers WOW approached 127 potential participants (of whom 100 joined the WOW registry) and screened 35 participants for open ACTG studies. The Emory WOW approached 120 participants, enrolling 86 into the WOW registry, and screened 51 potential participants for open ACTG studies during the WOW's tenure. The majority of women screened at both sites were women of color. CONCLUSIONS The WOW study team identified several lessons learned that can inform future efforts to engage women living with HIV in clinical research. First, success in engaging women is proportional to level of funding and institutional support. Second, there is a need for a more gender-inclusive scientific agenda as women are more likely to participate if studies address topics of interest to them. Third, meaningful engagement is a two-way street.
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Affiliation(s)
- Elizabeth Barr
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS), Baltimore, MD, USA.,Department of Gender, Women's, & Sexuality Studies, UMBC, Baltimore, MD, USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Shobha Swaminathan
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Carlos Del Rio
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Danielle M Campbell
- College of Medicine, Department of Preventive and Social Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Marta Paez-Quinde
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Susan E Cohn
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Self-efficacy as a mediator of patient navigation interventions to engage persons living with HIV and substance use. Drug Alcohol Depend 2021; 221:108567. [PMID: 33610093 PMCID: PMC8067954 DOI: 10.1016/j.drugalcdep.2021.108567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND People living with HIV who report substance use (PLWH-SU) face many barriers to care, resulting in an increased risk for poor health outcomes and the potential for ongoing disease transmission. This study evaluates the mechanisms by which Patient Navigation (PN) and Contingency Management (CM) interventions may work to address barriers to care and improve HIV outcomes in this population. METHODS Mediation analysis was conducted using data from a randomized, multi-site trial testing PN interventions to improve HIV care outcomes among 801 hospitalized PLHW-SU. Direct and indirect effects of PN and PN + CM were evaluated through five potential mediators-psychosocial conditions, healthcare avoidance, financial hardship, system barriers, and self-efficacy for HIV treatment adherence-on engagement in HIV care and viral suppression. RESULTS The PN + CM intervention had an indirect effect on improving engagement in HIV care at 6 months by increasing self-efficacy for HIV treatment adherence (β = 0.042, 95% CI = 0.008, 0.086). PN + CM also led to increases in viral suppression at 6 months (β = 0.090, 95% CI = 0.023, 0.168) and 12 months (β = 0.069, 95% CI = 0.009, 0.129) via increases in self-efficacy, although the direct effects were not significant. No mediating effects were observed for PN alone. CONCLUSION PN + CM interventions for PLWH-SU can increase an individual's self-efficacy for HIV treatment adherence, which in turn improves engagement in care at 6 months and may contribute to viral suppression over 12 months. Building self-efficacy may be a key factor in the success of such interventions and should be considered as a primary goal of PN + CM in practice.
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Norberg A, Nelson J, Holly C, Jewell ST, Lieggi M, Salmond S. Experiences of HIV-infected adults and healthcare providers with healthcare delivery practices that influence engagement in US primary healthcare settings: a qualitative systematic review. ACTA ACUST UNITED AC 2020; 17:1154-1228. [PMID: 30994499 DOI: 10.11124/jbisrir-2017-003756] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a major public health problem that has claimed the lives of more than 34 million people worldwide. The health of people living with HIV (PLWH) is optimized by ongoing engagement in HIV care, yet many people living with HIV either do not enter or fall out of care. Access to care and ongoing engagement in care for antiretroviral (ARV) medication adherence and psychoeducational support are critical to achieving the desired outcomes of reducing the risk of further HIV transmission and HIV related morbidity and mortality, and managing other commonly co-occurring health, social and behavioral conditions, thereby maximizing wellness. OBJECTIVE The objective of the review was to identify, evaluate and synthesize existing qualitative evidence on the experiences of HIV-infected adults with healthcare systems/practices/processes, and the experiences of healthcare providers with healthcare systems/practices/processes that impact engagement in primary healthcare settings in the United States (US). INCLUSION CRITERIA The review included studies reporting on the qualitative experiences of HIV-infected adults, aged 18-65 years, with healthcare systems, practices and processes and their healthcare providers (physicians, nurses and others providing care to these patients in the primary care healthcare setting). Qualitative studies including but not limited to designs such as phenomenology, ethnography, grounded theory, action research and qualitative descriptive were included. Studies published in languages other than English and conducted outside of the US were excluded. METHODS Using a three-step search strategy, databases of published and unpublished articles were searched from 1997 to 2017. All included studies were assessed by two independent reviewers for methodological quality, and data was extracted and pooled using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Findings were rated according to their level of credibility, categorized based on similarity in meaning and subjected to a meta-synthesis. RESULTS A total of 1038 qualitative articles were identified of which 41 were included after critical appraisal. Meta-synthesis generated four synthesized findings: i) What I want from my provider: to be a respectful, empathetic and holistic partner in my care; ii) I cannot do it alone: the critical importance of actively guiding and assisting patients during transitions and securing the needed resources; iii) Help me to understand my illness and care needs; iv) One-stop care that is de-stigmatizing and welcoming to diverse cultures keeps clients in care. These synthesized findings were derived from 243 study findings that were subsequently aggregated into 19 categories. Of the 243 study findings, 240 were rated unequivocal and three were rated credible. The overall ConQual for each of the four synthesized findings was moderate due to common dependability issues across the included studies. A total of 1597 participants were included. Only two studies were included from 1997 to 2000. The majority of included studies were published from 2005 to 2017. CONCLUSIONS The synthesized findings illustrate clear quality indicators for primary care practice, emphasizing the patient-provider-care team partnership and shared decision making that is holistic, takes into account a patient's whole life, responsibilities and stressors, and reframes HIV associated misperceptions/myths. The review also highlights the importance of helping patients navigate and interact with the healthcare system by offering one-stop services that assist with multiple medical care needs and "wraparound" services that provide the needed care coordination to assist with critical quality of life needs such as food, housing, transportation, and assistance with applying for health insurance and medication.
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Affiliation(s)
- Andrea Norberg
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The François Xavier Bagnoud Center, Rutgers, The State University of New Jersey, Newark, USA
| | - John Nelson
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The François Xavier Bagnoud Center, Rutgers, The State University of New Jersey, Newark, USA
| | - Cheryl Holly
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Centre of Excellence
| | - Sarah T Jewell
- George F. Smith Library of the Health Sciences, Rutgers, The State University of New Jersey, Newark, USA
| | - Michelle Lieggi
- Fishbon Library, University of California San Francisco Medical Center, San Francisco, USA
| | - Susan Salmond
- School of Nursing, Rutgers, The State University of New Jersey, Newark, USA.,The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Centre of Excellence
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Eliacin J, Matthias MS, Burgess DJ, Patterson S, Damush T, Pratt-Chapman M, McGovern M, Chinman M, Talib T, O'Connor C, Rollins A. Pre-implementation Evaluation of PARTNER-MH: A Mental Healthcare Disparity Intervention for Minority Veterans in the VHA. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:46-60. [PMID: 32399857 DOI: 10.1007/s10488-020-01048-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To design PARTNER-MH, a peer-led, patient navigation program for implementation in Veterans Health Administration (VHA) mental health care settings, we conducted a pre-implementation evaluation during intervention development to assess stakeholders' views of the intervention and to explore implementation factors critical to its future adoption. This is a convergent mixed-methods study that involved qualitative semi-structured interviews and survey data. Data collection was guided by the Consolidated Framework for Implementation Research (CFIR). We interviewed and administered the surveys to 23 peers and 10 supervisors from 12 midwestern VHA facilities. We used deductive and inductive approaches to analyze the qualitative data. We also conducted descriptive analysis and Fisher Exact Test to compare peers and supervisors' survey responses. We triangulated findings to refine the intervention. Overall, participants viewed PARTNER-MH favorably. However, they saw the intervention's focus on minority Veterans and social determinants of health framework as potential barriers, believing this could negatively affect the packaging of the intervention, complicate its delivery process, and impact its adoption. They also viewed clinic structures, available resources, and learning climate as potential barriers. Peers and supervisors' selections and discussions of CFIR items were similar. Our findings informed PARTNER-MH development and helped identify factors that could impact its implementation. This project is responsive to the increasing recognition of the need to incorporate implementation science in healthcare disparities research. Understanding the resistance to the intervention's focus on minority Veterans and the potential barriers presented by contextual factors positions us to adjust the intervention prior to testing, in an effort to maximize implementation success.
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Affiliation(s)
- Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA.
- Psychology Department, ACT Center of Indiana, IUPUI, Indianapolis, USA.
- Regenstrief Institute, Inc, Indianapolis, IN, USA.
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- Department of Communication Studies, IUPUI, Indianapolis, USA
| | - Diana J Burgess
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Scott Patterson
- Department of Psychiatry, Richard L. Roudebush VAMC, Indianapolis, IN, USA
| | - Teresa Damush
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- General Internal Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives & Health Equity, George Washington University Cancer Center, Washington, DC, USA
| | - Mark McGovern
- Psychiatry & Behavioral Sciences; Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew Chinman
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - Caitlin O'Connor
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
| | - Angela Rollins
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Psychology Department, ACT Center of Indiana, IUPUI, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
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Pinto RM, Choi CJ, Wall MM. Developing a Scale to Measure Interprofessional Collaboration in HIV Prevention and Care: Implications for Research on Patient Access and Retention in the HIV Continuum of Care. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:36-50. [PMID: 32073308 DOI: 10.1521/aeap.2020.32.1.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
To adapt and validate a scale for measuring interprofessional collaboration in HIV prevention and care (IPC-HIV), primary survey data were collected (2012-2017) from 577 HIV service providers in 60 organizations in New York, New Jersey, and Michigan. Cross-sectional training data were used to develop the IPC-HIV scale. The model was validated by fitting the five-factor confirmatory factor-analysis model to a 30-item set. The scale measures five domains with reliable alpha coefficients: Interdependence, Professional Activities, Flexibility, Collective Ownership, and Reflection on Process. Correlations between subscales were significant (p < .05). The strongest correlation was between Reflection on Process and Collective Ownership subscale scores. Mean scores ranged lfrom 4.070 to 4.880, with the highest score for Flexibility across all locations. IPC-HIV is valid and reliable among HIV-prevention and care workers, and is recommended for examining the effect of IPC on patient access to HIV testing and primary care.
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Affiliation(s)
- Rogério M Pinto
- School of Social Work, University of Michigan-Ann Arbor, Ann Arbor, Michigan
| | - C Jean Choi
- Division of Biostatistics, New York State Psychiatric Institute, New York, New York
| | - Melanie M Wall
- Division of Biostatistics in Psychiatry, New York State Psychiatric Institute
- Division of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
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Ramlakhan JU, Foster AM, Grace SL, Green CR, Stewart DE, Gagliardi AR. What constitutes patient-centred care for women: a theoretical rapid review. Int J Equity Health 2019; 18:182. [PMID: 31771588 PMCID: PMC6880419 DOI: 10.1186/s12939-019-1048-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/05/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Women experience disparities in health care delivery and outcomes. Patient-centred care for women (PCCW) is needed. This study examined how PCC has been conceptualized and operationalized in women's health research. METHODS We conducted a theoretical rapid review of PCCW in MEDLINE, EMBASE, CINAHL and SCOPUS from 2008 to 2018 for studies involving women aged 18 years or greater with any condition, and analyzed data using an established 6-domain framework of patient-centred communication. RESULTS We included 39 studies, which covered the following clinical areas: maternal care, cancer, diabetes, HIV, endometriosis, dementia, distal radius fracture, overactive bladder, and lupus erythematosus. The 34 (87.2%) studies that defined or described PCC varied in the PCC elements they addressed, and none addressed all 6 PCC domains. Common domains were exchanging information (25, 73.5%) and fostering the patient-clinician relationship (22, 64.7%). Fewer studies addressed making decisions (16, 47.1%), enabling patient self-management (15, 44.1%), responding to emotions (12, 35.3%), or managing uncertainty (1, 2.9%). Compared with mixed-gender studies, those comprised largely of women more frequently prioritized exchanging information above other domains. Few studies tested strategies to support PCCW or evaluated the impact of PCCW; those that did demonstrated beneficial impact on patient knowledge, satisfaction, well-being, self-care and clinical outcomes. CONCLUSIONS Studies varied in how they conceptualized PCCW, and in many it was defined narrowly. Few studies examined how to implement or measure PCCW; thus, we lack insight on how to operationlize PCCW. Thus, further research is needed to confirm this, and whether PCCW differs across conditions, knowledge needed to inform policies, guidelines and measures aimed at improving health care and associated outcomes for women.
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Affiliation(s)
- Jessica U Ramlakhan
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Sherry L Grace
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada
| | - Courtney R Green
- Society of Obstetricians & Gynecologists of Canada, 2781 Lancaster Road, Suite 200, Ottawa, ON, K1B 1A7, Canada
| | - Donna E Stewart
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G 2C4, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G 2C4, Canada.
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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 2019; 21:25-36. [PMID: 31597497 DOI: 10.1177/1524839919875727] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient navigation is increasingly utilized to link and (re)engage persons with HIV to care. Understanding client experiences with HIV patient navigation can facilitate intervention design and translation of evidence to practice. We conducted a qualitative meta-synthesis of client experiences with HIV patient navigation. Data were analyzed using thematic synthesis. We identified seven relevant studies; all collected data via in-depth interviews with persons with HIV who participated in HIV patient navigation. Four interrelated themes emerged from analysis that pertain to (1) the complexity of the health and social service environment and the holistic approaches taken by the navigator, (2) the profound significance of the client-navigator relationship, (3) client reluctance to end the navigation program, and (4) client self-efficacy and feelings of hope and psychological change as a result of their navigation experience. The unifying theme across all studies was the value and impact of the client-navigator relationship on client experience and quality of life. Programs should consider hiring navigators who possess strong relational skills and are peers of the clients, and clearly delineating the role of the navigator. Research should examine the impact of the client-navigator relationship on client outcomes and further investigate how participating in patient navigation affects client self-efficacy, client resiliency, and the role of posttraumatic growth to achieve improved HIV outcomes. This review underscores the significance of the relationship within intensive, multilevel interventions for individuals and communities marginalized and isolated from health and social service systems.
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Affiliation(s)
| | - Darrel H Higa
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Yuko Mizuno
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia B DeLuca
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda J Koenig
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Mulatu MS, Hoyte T, Williams KM, Taylor RD, Painter T, Spikes P, Prather C, Jeffries WL, Henny K, Shabu T. Cross-site Monitoring and Evaluation of the Care and Prevention in the United States Demonstration Project, 2012-2016: Selected Process and Short-term Outcomes. Public Health Rep 2019; 133:87S-100S. [PMID: 30457956 DOI: 10.1177/0033354918803368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The Care and Prevention in the United States (CAPUS) Demonstration Project was a 4-year (2012-2016) cross-agency demonstration project that aimed to reduce HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in 8 states (Georgia, Illinois, Louisiana, Mississippi, Missouri, North Carolina, Tennessee, and Virginia). Its goals were to increase the identification of undiagnosed HIV infections and optimize the linkage to, reengagement with, and retention in care and prevention services for people with HIV (PWH). We present descriptive findings to answer selected cross-site process and short-term outcome monitoring and evaluation questions. METHODS We answered a set of monitoring and evaluation questions by using data submitted by grantees. We used a descriptive qualitative method to identify key themes of activities implemented and summarized quantitative data to describe program outputs and outcomes. RESULTS Of 155 343 total HIV tests conducted by all grantees, 558 (0.36%) tests identified people with newly diagnosed HIV infection. Of 4952 PWH who were presumptively not in care, 1811 (36.6%) were confirmed as not in care through Data to Care programs. Navigation and other linkage, retention, and reengagement programs reached 10 382 people and linked to or reengaged with care 5425 of 7017 (77.3%) PWH who were never in care or who had dropped out of care. Programs offered capacity-building trainings to providers to improve cultural competency, developed social marketing and social media campaigns to destigmatize HIV testing and care, and expanded access to support services, such as transitional housing and vocational training. CONCLUSIONS CAPUS grantees substantially expanded their capacity to deliver HIV-related services and reach racial/ethnic minority groups at risk for or living with HIV infection. Our findings demonstrate the feasibility of implementing novel and integrated programs that address social and structural barriers to HIV care and prevention.
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Affiliation(s)
- Mesfin S Mulatu
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tamika Hoyte
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kim M Williams
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Raekiela D Taylor
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Painter
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pilgrim Spikes
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia Prather
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William L Jeffries
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kirk Henny
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Nurturing Practitioner-Researcher Partnerships to Improve Adoption and Delivery of Research-Based Social and Public Health Services Worldwide. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050862. [PMID: 30857292 PMCID: PMC6427324 DOI: 10.3390/ijerph16050862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/21/2019] [Accepted: 03/05/2019] [Indexed: 12/15/2022]
Abstract
Research-based practices—psychosocial, behavioral, and public health interventions—have been demonstrated to be effective and often cost-saving treatments, but they can take up to two decades to reach practitioners within the health and human services workforce worldwide. Practitioners often rely on anecdotal evidence and their “practice wisdom” rather than on research, and may thus unintentionally provide less effective or ineffective services. Worldwide, community engagement in research is recommended, particularly in low-resource contexts. However, practitioner involvement has not been adequately explored in its own right as an innovative community-engaged practice that requires a tailored approach. The involvement of practitioners in research has been shown to improve their use of research-based interventions, and thus the quality of care and client outcomes. Nevertheless, the literature is lacking specificity about when and how (that is, using which tasks and procedures) to nurture and develop practitioner–researcher partnerships. This paper offers theoretical and empirical evidence on practitioner–researcher partnerships as an innovation with potential to enhance each phase of the research cycle and improve services, using data from the United States, Brazil, and Spain. Recommendations for partnership development and sustainability are offered, and a case is made for involving practitioners in research in order to advance social justice by amplifying the local relevance of research, increasing the likelihood of dissemination to community settings, and securing the sustainability of research-based interventions in practice settings.
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Evaluating a professional patient navigation intervention in a supportive care setting. Support Care Cancer 2019; 27:3281-3290. [PMID: 30612239 DOI: 10.1007/s00520-018-4622-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Unmet supportive care needs are common among cancer patients. This study evaluates a patient navigation intervention (i.e., specially trained oncology nurse who monitors, advises, and (if needed) refers patients to supportive cancer care) in terms of need, satisfaction, advice uptake, and consumption of supportive cancer care. METHODS Using a cross-sectional design, the intervention was evaluated among healthcare professionals, patients who participated, and patients who did not participate in the intervention. All patients were newly diagnosed with breast cancer or melanoma. Data was collected through medical records and online surveys. RESULTS In total, 1091 patients were offered patient navigation. Most of these patients (755) were willing to consult the patient navigator (PN). Approximately 90% of patients who completed both the intervention and the questionnaire (N = 120, response rate 54%) perceived the PN as valuable, accessible, and reliable. Approximately 80% of respondents who needed advice regarding nutrition (n = 67), fatigue (n = 98), emotions (n = 106), and work (n = 79) were adequately informed by the PN. Of the 120 respondents, 59 used some form of supportive cancer care. Most of the responding healthcare professionals (N = 70, response rate 45%) perceived the intervention as a valuable addition to current cancer care (n = 51) and mentioned that the PN should be available to all patients (n = 54). CONCLUSIONS The intervention was perceived as valuable by both patients and healthcare professionals. The results may, however, been biased by the large number of patients who were omitted from participation due to logistical reasons.
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Schumann CL, Westergaard RP, Meier AE, Ruetten ML, Vergeront JM. Developing a Patient Navigation Program to Improve Engagement in HIV Medical Care and Viral Suppression: A Demonstration Project Protocol. AIDS Behav 2019; 23:5-13. [PMID: 28283775 DOI: 10.1007/s10461-017-1727-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Individuals diagnosed and living with HIV who are out of care or who have persistent viremia are at risk for poor health outcomes and are estimated to account for two-thirds of all new HIV infections. As part of a six-state demonstration project to improve access to care for hard-to-reach populations, Wisconsin developed an HIV-specific patient navigation program to improve engagement in HIV care and viral suppression for populations at risk for poor HIV care outcomes. Patient navigators worked with individuals who were out of HIV medical care or were at risk of falling out of care over nine months to identify and address barriers to care. This manuscript describes the patient navigation program and rationale, and lessons learned that should be considered by sites developing similar programs.
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Affiliation(s)
- Casey L Schumann
- AIDS/HIV Program, Division of Public Health, Wisconsin Department of Health Services, Madison, WI, USA.
- , 1 West Wilson St., Room 265, Madison, WI, 53703, USA.
| | - Ryan P Westergaard
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alison E Meier
- University of Wisconsin Medical Foundation, Madison, WI, USA
| | - Mari L Ruetten
- AIDS/HIV Program, Division of Public Health, Wisconsin Department of Health Services, Madison, WI, USA
| | - James M Vergeront
- AIDS/HIV Program, Division of Public Health, Wisconsin Department of Health Services, Madison, WI, USA
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Pinto RM, Witte SS, Filippone P, Choi CJ, Wall M. Interprofessional Collaboration and On-the-Job Training Improve Access to HIV Testing, HIV Primary Care, and Pre-Exposure Prophylaxis (PrEP). AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:474-489. [PMID: 30966764 PMCID: PMC6460934 DOI: 10.1521/aeap.2018.30.6.474] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The HIV Continuum of Care is a global priority, yet vulnerable patients face access/retention challenges. Research is missing on the role social and public health service providers can play to help these patients. Using structural equation modeling, we examined the effects of interprofessional collaboration (IPC) and on-the-job training on the frequency of linkages to HIV testing, HIV primary care, and on pre-exposure prophylaxis (PrEP) psychoeducation. The sample included 285 New York City providers of social and public health services from 34 agencies. Forty-eight percent of providers had not offered PrEP psychoeducation and linked fewer than five patients to HIV testing and primary care per week. However, in multivariate analysis higher IPC was associated with more linkages and frequent psychoeducation. After adjusting for IPC, linkage training was associated with more frequent services. The influence of specific factors highlights areas for interventions and policies to improve access to the HIV Continuum of Care.
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Affiliation(s)
- Rogério M Pinto
- University of Michigan School of Social Work, Ann Arbor, Michigan
| | - Susan S Witte
- Columbia University School of Social Work, New York, New York
| | - Prema Filippone
- Columbia University School of Social Work, New York, New York
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The Role of Patient Navigators in Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:276-282. [PMID: 28079645 PMCID: PMC5381478 DOI: 10.1097/phh.0000000000000512] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONTEXT People living with human immunodeficiency virus (HIV) (PLWH) who are most at risk for falling out of HIV primary care and detectable viral loads include homeless and unstably housed individuals and those codiagnosed with behavioral health disorders. The patient-centered medical home (PCMH) is a model that promotes provision of comprehensive, patient-centered, accessible, coordinated, and quality care for patients. This initiative provided patient navigation to HIV-positive homeless and unstably housed individuals codiagnosed with a mental health or substance use disorder as a means to create an adapted PCMH to meet the specific needs of this population. OBJECTIVE The purpose of this analysis was to characterize the roles and responsibilities of patient navigators as part of an effort to create a medical home for homeless and unstably housed PLWH with behavioral health comorbidities. DESIGN Eighty-one in-depth interviews with clinic staff and 2 focus groups with patient navigators were conducted. Content analysis was performed to identify key roles and responsibilities of the patient navigators. RESULTS Patient navigators played an important role in creating a PCMH by working with clients to schedule and complete appointments, develop comprehensive care plans, forging critical relationships with providers both within and outside of health care systems, providing holistic support to increase patient self-management, and assisting in achieving housing stability. CONCLUSIONS It may be necessary to adapt the traditional PCMH model to effectively meet the social, behavior health, and medical needs of homeless and unstably housed PLWH with behavioral health comorbidities. A patient navigator who can invest time in supporting and connecting these patients to needed services may be a key component in creating an effective PCMH for this population. These findings highlight the roles and tasks of patient navigators that may contribute to developing a PCMH specific to homeless and unstably housed PLWH with mental health and substance use comorbidities. Implementation of such a model has the potential to improve health outcomes (such as retention in care and viral suppression) for particularly vulnerable PLWH and thereby reduce the burden of HIV infection.
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Adam GP, Di M, Cu-Uvin S, Halladay C, Smith BT, Iyer S, Trikalinos TA. Strategies for improving the lives of US women aged 40 and above living with HIV/AIDS: an evidence map. Syst Rev 2018; 7:25. [PMID: 29391059 PMCID: PMC5796491 DOI: 10.1186/s13643-018-0684-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/12/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND While in its early years the HIV epidemic affected primarily the male and the young, nowadays, the population living with HIV/AIDS is approximately 24% women, and its age composition has shifted towards older ages. Many of the older women who live with HIV/AIDS also live with the medical and social conditions that accompany aging. This work aims to identify and characterize empirical studies of strategies for the comprehensive management of women over 40, including transgender women, who live with HIV/AIDS. Forty was chosen as an operational age cutoff to identify premenopausal women who are less likely to bear children, as well as peri- and postmenopausal women. METHODS We conducted a literature search after discussions with a diverse panel of content experts and other stakeholders and developed an evidence map that identified 890 citations that address questions having to do with programs and barriers to engaging with programs, as well as the role of insurance and comorbidities, and have enrolled older women who live with HIV/AIDS. RESULTS Of these, only 37 (4%) reported results of interest for women over 40 who live with HIV/AIDS, or examined interactions between gender and older age that would allow predictions in this subgroup. Few of the 37 eligible studies focused on women facing obvious challenges, such as immigrants, transgender, physically abused, or those recently released from prison. No studies focused on women caring for dependents, including children and grandchildren, or those diagnosed after age 40. CONCLUSION The evidence base that is directly applicable to women over 40 who live with HIV/AIDS in the USA is limited, and the research need is broad. We propose research prioritization strategies for this population.
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Affiliation(s)
- Gaelen P Adam
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.
| | - Mengyang Di
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Susan Cu-Uvin
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA.,Department of Ob-Gyn and Medicine, Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Christopher Halladay
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Bryant T Smith
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA
| | - Suchitra Iyer
- Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Thomas A Trikalinos
- Brown Evidence-based Practice Center, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, USA
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Duggleby W, Pesut B, Cottrell L, Friesen L, Sullivan K, Warner G. Development, Implementation, and Evaluation of a Curriculum to Prepare Volunteer Navigators to Support Older Persons Living With Serious Illness. Am J Hosp Palliat Care 2017; 35:780-787. [PMID: 29129107 DOI: 10.1177/1049909117740122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this article is to report the development, implementation, and evaluation of a curriculum designed to prepare volunteer navigators to support community-dwelling older persons with serious chronic illness. The role of the volunteer navigator was to facilitate independence and quality of life through building social connections, improving access to resources, and fostering engagement. A curriculum was constructed from evidence-based competencies, piloted and revised, and then implemented in 7 subsequent workshops. Workshop participants were 51 volunteers and health-care providers recruited through local hospice societies and health regions. Curriculum was evaluated through satisfaction and self-efficacy questionnaires completed at workshop conclusion. Postworkshop evaluation indicated a high degree of satisfaction with the training. One workshop cohort of 7 participants was followed for 1 year to provide longitudinal evaluation data. Participants followed longitudinally reported improved self-efficacy over 12 months and some challenges with role transition. Future improvements will include further structured learning opportunities offered by telephone postworkshop, focusing on advocacy, communication, and conflict management. Overall, volunteers were satisfied with the curriculum and reported good self-perceived efficacy in their new role as navigators.
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Affiliation(s)
- Wendy Duggleby
- 1 Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Barbara Pesut
- 2 Faculty of Health and Social Development, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Laura Cottrell
- 1 Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Lynnelle Friesen
- 3 School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Kelli Sullivan
- 3 School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
| | - Grace Warner
- 4 School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
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Chuah FLH, Haldane VE, Cervero-Liceras F, Ong SE, Sigfrid LA, Murphy G, Watt N, Balabanova D, Hogarth S, Maimaris W, Otero L, Buse K, McKee M, Piot P, Perel P, Legido-Quigley H. Interventions and approaches to integrating HIV and mental health services: a systematic review. Health Policy Plan 2017; 32:iv27-iv47. [PMID: 29106512 PMCID: PMC5886062 DOI: 10.1093/heapol/czw169] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The frequency in which HIV and AIDS and mental health problems co-exist, and the complex bi-directional relationship between them, highlights the need for effective care models combining services for HIV and mental health. Here, we present a systematic review that synthesizes the literature on interventions and approaches integrating these services. METHODS This review was part of a larger systematic review on integration of services for HIV and non-communicable diseases. Eligible studies included those that described or evaluated an intervention or approach aimed at integrating HIV and mental health care. We searched multiple databases from inception until October 2015, independently screened articles identified for inclusion, conducted data extraction, and assessed evaluative papers for risk of bias. RESULTS Forty-five articles were eligible for this review. We identified three models of integration at the meso and micro levels: single-facility integration, multi-facility integration, and integrated care coordinated by a non-physician case manager. Single-site integration enhances multidisciplinary coordination and reduces access barriers for patients. However, the practicality and cost-effectiveness of providing a full continuum of specialized care on-site for patients with complex needs is arguable. Integration based on a collaborative network of specialized agencies may serve those with multiple co-morbidities but fragmented and poorly coordinated care can pose barriers. Integrated care coordinated by a single case manager can enable continuity of care for patients but requires appropriate training and support for case managers. Involving patients as key actors in facilitating integration within their own treatment plan is a promising approach. CONCLUSION This review identified much diversity in integration models combining HIV and mental health services, which are shown to have potential in yielding positive patient and service delivery outcomes when implemented within appropriate contexts. Our review revealed a lack of research in low- and middle- income countries, and was limited to most studies being descriptive. Overall, studies that seek to evaluate and compare integration models in terms of long-term outcomes and cost-effectiveness are needed, particularly at the health system level and in regions with high HIV and AIDS burden.
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Affiliation(s)
- Fiona Leh Hoon Chuah
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Victoria Elizabeth Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Francisco Cervero-Liceras
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Louise A Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Georgina Murphy
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicola Watt
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Dina Balabanova
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Sue Hogarth
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
- London Borough of Waltham Forest, UK
| | - Will Maimaris
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
- Haringey Council, UK
| | - Laura Otero
- Nursing Section, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Kent Buse
- CIBER of Epidemiology and Public Health (CIBERESP-ISCIII), Madrid, Spain
| | - Martin McKee
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Pablo Perel
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
- The World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
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The North Carolina HIV Bridge Counselor Program: Outcomes From a Statewide Level Intervention to Link and Reengage HIV-Infected Persons in Care in the South. J Acquir Immune Defic Syndr 2017; 76:e7-e14. [PMID: 28394820 DOI: 10.1097/qai.0000000000001389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To improve the HIV continuum of care, a team of field service interventionists (State Bridge Counselors, SBC) was developed through a state public health system and provided brief (1-2) contacts for linkage of newly diagnosed persons with HIV and reengagement of persons living with HIV (PLWH) who were not in care. SETTING North Carolina, United States. METHODS Service data from January 2013 to June 2015 were analyzed to determine characteristics of clients referred to SBCs, proportions linked or reengaged in care, and/or achieved viral load suppression (VLs). We evaluated associations between client characteristics and outcomes using multivariable analyses and estimated odds ratios (OR) with 95% confidence intervals (CI). RESULTS SBCs provided linkage services to 299 newly diagnosed individuals and reengagement services to 606 PLWH throughout North Carolina. Among persons who received linkage services, 189 (63%) had evidence of care within 90 days of referral and 205 (69%) had VLs within a year. Among PLWH who received reengagement services, 278 (46%) had care within 90 days and 308 (51%) had VLs within a year. Persons aged 30-39 years (OR, 2.1; 95% CI, 1.1 to 3.9) and 40-49 years had an increased likelihood (OR, 2.4; 95% CI, 1.1 to 5.2) of linkage within 90 days compared with persons aged 18-29 years. Non-white PLWH had an increased OR of 1.7; (95% CI, 1.2 to 2.5) of reengagement compared with whites. CONCLUSIONS Our SBC program successfully implemented a "low-touch" approach to provision of linkage and reengagement services, demonstrating that public health resources can be used to address the HIV care continuum on a statewide level.
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Asamsama OH, Squires L, Tessema A, Rae E, Hall K, Williams R, Benator D. HIV Nurse Navigation: Charting the Course to Improve Engagement in Care and HIV Virologic Suppression. J Int Assoc Provid AIDS Care 2017; 16:603-607. [PMID: 29017375 PMCID: PMC11119006 DOI: 10.1177/2325957417732835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study represents one of the few exploring the effectiveness of an integrated HIV nurse navigation program on engagement and virologic outcomes. A navigator provided individualized care management (eg, pillbox renewals), intensive outreach, and collaboration with existing support systems (eg, families, community programs). Clinical data from the Veterans Affairs (VA) Medical Center site of a longitudinal, observational study of HIV in the District of Columbia (DC) cohort were used for comparison (N = 706). Navigation patients (n = 84) were less likely to have permanent housing, and more likely to be disabled, have detectable viral load, comorbid depressive, and substance use disorders. Navigation patients showed improvements in clinic visits (doubled), rate of medication renewal (40.91% to 80.61%), CD4 count and CD4%, and viral rates of Veterans with <200 copies/mL increased from 47.6% to 69.0% after one year. Integration of nurse navigation into a HIV primary care setting shows promise in improving engagement and virologic suppression in a high-risk population.
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Affiliation(s)
| | - Leah Squires
- Washington DC VA Medical Center, Washington DC, USA
| | | | - Ephrem Rae
- Yale University, Global Affairs Department, New Haven, CT, USA
| | - Karen Hall
- Durham Veterans Affairs Medical Center, Durham, NC, USA
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Westergaard RP, Genz A, Panico K, Surkan PJ, Keruly J, Hutton HE, Chang LW, Kirk GD. Acceptability of a mobile health intervention to enhance HIV care coordination for patients with substance use disorders. Addict Sci Clin Pract 2017; 12:11. [PMID: 28441962 PMCID: PMC5405459 DOI: 10.1186/s13722-017-0076-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/30/2017] [Indexed: 11/21/2022] Open
Abstract
Background Persons living with HIV and substance use disorders face barriers to sustained engagement in medical care, leading to suboptimal antiretroviral treatment outcomes. Innovative mobile technology tools such as customizable smartphone applications have the potential to enhance existing care coordination programs, but have not been rigorously studied. Methods We developed and implemented a two-component intervention consisting of peer health navigation supported by a smartphone application conducting ecologic momentary assessment (EMA) of barriers to care and medication adherence. Patients with a history of antiretroviral treatment failure and substance use were recruited to participate in the 9-month pilot intervention. Three peer health navigators were trained to provide social and logistical support while participants re-engaged in HIV care. We assessed the acceptability of the intervention components using qualitative analysis of in-depth interviews conducted with study participants and peer navigators. Results Of 19 patients enrolled in the study, 17 participated for at least 2 months and 15 completed the entire 9-month study protocol. The acceptability of the peer navigation intervention was rated favorably by all participants interviewed, who felt that peer support was instrumental in helping them re-engage in HIV care. Participants also responded favorably to the smartphone application, but described its usefulness mostly as providing reminders to take medications and attend appointments, rather than as a facilitator of patient navigation. Conclusions Peer health navigation and smartphone-based EMA are acceptable approaches to facilitating engagement in HIV care for drug using populations. Future studies to evaluate the efficacy of this approach for improving long-term retention in care and antiretroviral treatment outcomes are warranted. ClinicalTrials.gov Identifier NCT01941108; registered on September 4, 2013
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Affiliation(s)
- Ryan P Westergaard
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. .,University of Wisconsin-Madison, 1685 Highland Ave, MFCB 5223, Madison, WI, 53705-2281, USA.
| | - Andrew Genz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristen Panico
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeanne Keruly
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Heidi E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Larry W Chang
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Fletcher F, Ingram LA, Kerr J, Buchberg M, Bogdan-Lovis L, Philpott-Jones S. "She Told Them, Oh That Bitch Got AIDS": Experiences of Multilevel HIV/AIDS-Related Stigma Among African American Women Living with HIV/AIDS in the South. AIDS Patient Care STDS 2016; 30:349-56. [PMID: 27410498 DOI: 10.1089/apc.2016.0026] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
African American women bear a disproportionate burden of HIV/AIDS in the United States. Although they constitute only 13% of the US population, African Americans account for nearly 65% of all new HIV infections among American women. In addition, this population suffers comparatively greater adverse health outcomes related to HIV status. African American women living with HIV in the South may be further burdened by HIV/AIDS stigma, which is comparatively more pronounced in this region. To further explore this burden, we used narrative data and the Social Ecological Model to explore how African American women living with HIV in the US South recount, conceptualize, and cope with HIV/AIDS stigma at interpersonal, community, and institutional levels. Our narrative analysis suggests that HIV-positive African American women living in the South are vulnerable to experiences of multilevel HIV stigma in various settings and contexts across multiple domains of life. Stigma subsequently complicated disclosure decisions and made it difficult for women to feel supported in particular social, professional and medical settings that are generally regarded as safe spaces for noninfected individuals. Findings suggest that the debilitating and compounded effect of multilevel HIV/AIDS stigma on HIV-positive African American women in the South warrants closer examination to tailor approaches that effectively address the unique needs of this population.
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Affiliation(s)
- Faith Fletcher
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, Illinois
| | - Lucy Annang Ingram
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky
| | - Meredith Buchberg
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Libby Bogdan-Lovis
- Center for Ethics and Humanities in the Life Sciences, East Lansing, Michigan
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Tso LS, Best J, Beanland R, Doherty M, Lackey M, Ma Q, Hall BJ, Yang B, Tucker JD. Facilitators and barriers in HIV linkage to care interventions: a qualitative evidence review. AIDS 2016; 30:1639-53. [PMID: 27058350 PMCID: PMC4889545 DOI: 10.1097/qad.0000000000001101] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To synthesize qualitative evidence on linkage to care interventions for people living with HIV. DESIGN Systematic literature review. METHODS We searched 19 databases for studies reporting qualitative evidence on linkage interventions. Data extraction and thematic analysis were used to synthesize findings. Quality was assessed using the Critical Appraisal Skills Programme tool and certainty of evidence was evaluated using the Confidence in the Evidence from Reviews of Qualitative Research approach. RESULTS Twenty-five studies from 11 countries focused on adults (24 studies), adolescents (eight studies), and pregnant women (four studies). Facilitators included community-level factors (i.e., task shifting, mobile outreach, integrated HIV, and primary services, supportive cessation programs for substance users, active referrals, and dedicated case management teams), and individual-level factors (encouragement of peers/family and positive interactions with healthcare providers in transitioning into care). One key barrier for people living with HIV was perceived inability of providers to ensure confidentiality as part of linkage to care interventions. Providers reported difficulties navigating procedures across disparate facilities and having limited resources for linkage to care interventions. CONCLUSION Our findings extend the literature by highlighting the importance of task-shifting, mobile outreach, integrated HIV, and primary care services. Both community and individual-level factors may increase the feasibility and acceptability of HIV linkage to care interventions. These findings may inform policies to increase the reach of HIV services available in communities.
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Affiliation(s)
- Lai Sze Tso
- aUniversity of North Carolina Project-China, Guangzhou, ChinabInstitute for Global Health and Infectious Diseases at UNC-Chapel Hill, Chapel Hill, North Carolina, USAcGuangdong Provincial Center for STD Control, Guangzhou, ChinadSchool of Medicine, University of California, San Francisco, California, USAeHIV/AIDS Department World Health Organization, Geneva SwitzerlandfUniversity of Utah, Salt Lake City, Utah, USAgGuangzhou Eighth People's Hospital, Guangzhou, ChinahDepartment of Psychology, Global and Community Mental Health Research Group, University of Macau, Macau, ChinaiDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Zibrik K, Laskin J, Ho C. Integration of a nurse navigator into the triage process for patients with non-small-cell lung cancer: creating systematic improvements in patient care. ACTA ACUST UNITED AC 2016; 23:e280-3. [PMID: 27330366 DOI: 10.3747/co.23.2954] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nurse navigation is a developing facet of oncology care. The concept of patient navigation was originally created in 1990 at the Harlem Hospital Center in New York City as a strategy to assist vulnerable and socially disadvantaged populations with timely access to breast cancer care. Since the mid-1990s, navigation programs have expanded to include many patient populations that require specialized management and prompt access to diagnostic and clinical resources. Advanced non-small-cell lung cancer is ideally suited for navigation to facilitate efficient assessment in this fragile patient population and to ensure timely results of molecular tests for first-line therapy with appropriately targeted agents. At the BC Cancer Agency, nurse navigator involvement with thoracic oncology triage has been demonstrated to increase the proportion of patients receiving systemic treatment, to shorten the time to delivery of systemic treatment, and to increase the rate of molecular testing and the number of patients with molecular testing results available at time of initial consultation. Insights gained through the start-up process are briefly discussed, and a framework for implementation at other institutions is outlined.
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Affiliation(s)
| | | | - C Ho
- BC Cancer Agency, Vancouver, BC
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Brothers J, Hotton AL, Hosek SG, Harper GW, Fernandez MI. Young Women Living with HIV: Outcomes from a Targeted Secondary Prevention Empowerment Pilot Trial. AIDS Patient Care STDS 2016; 30:229-35. [PMID: 27158851 DOI: 10.1089/apc.2015.0294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Women account for 1 in 5 new HIV infections in the US, make up 24% of people living with HIV, and represent a quarter of AIDS diagnoses. Despite the need for continued prevention among young women living with HIV, there is very little in the literature on how best to reduce sexual risk and increase the health and well-being of young women living with HIV. This article explores the primary and secondary outcomes of a randomized controlled pilot trial of an intervention entitled EVOLUTION Young Women Taking Charge and Growing Stronger. This behavioral intervention aimed to decrease sexual risk and empower young women living with HIV by enhancing young women's knowledge and skills pertaining to HIV risk reduction as well as to the factors that increase women's vulnerability, such as sexual inequality, gender, and power imbalances. Findings from this trial demonstrate that group-based behavioral interventions for young women living with HIV have promise to reduce the total number of sexual partners and reduce unprotected vaginal and anal intercourse. However, more work is needed to understand how best to address the challenges young women face in their day to day lives that impact their sexual risk as well as their overall health and access to care and treatment.
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Affiliation(s)
- Jennifer Brothers
- Division of Child and Adolescent Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
| | - Anna L. Hotton
- Division of Child and Adolescent Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
| | - Sybil G. Hosek
- Division of Child and Adolescent Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
| | - Gary W. Harper
- Division of Child and Adolescent Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
| | - M. Isabel Fernandez
- Division of Child and Adolescent Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
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Xavier J, Cajina A. The special projects of national significance women of color initiative. AIDS Patient Care STDS 2015; 29 Suppl 1:S1-3. [PMID: 25458602 DOI: 10.1089/apc.2014.0270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica Xavier
- US Department of Health and Human Services, Health Resources and Services Administration, HIV-AIDS Bureau, Special Projects of National Significance, Rockville, Maryland
| | - Adan Cajina
- US Department of Health and Human Services, Health Resources and Services Administration, HIV-AIDS Bureau, Special Projects of National Significance, Rockville, Maryland
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