Enhancing patient navigation to improve intervention session attendance and viral load suppression of persons with HIV and substance use: a secondary post hoc analysis of the Project HOPE study

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

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Interventions are needed to improve viral suppression rates among persons with HIV and substance use. A 3-arm randomized multi-site study (Metsch et al. in JAMA 316:156-70, 2016) was conducted to evaluate the effect on HIV outcomes of usual care referral to HIV and substance use services (N = 253) versus patient navigation delivered alone (PN: N = 266) or together with contingency management (PN + CM; N = 271) that provided financial incentives targeting potential behavioral mediators of viral load suppression.

AIMS: This secondary analysis evaluates the effects of financial incentives on attendance at PN sessions and the relationship between session attendance and viral load suppression at end of the intervention.

METHODS: Frequency of sessions attended was analyzed over time and by distribution of individual session attendance frequency (PN vs PN + CM). Percent virally suppressed (≤200 copies/mL) at 6 months was compared for low, medium and high rate attenders. In PN + CM a total of $220 could be earned for attendance at 11 PN sessions over the 6-month intervention with payments ranging from $10 to $30 under an escalating schedule.

RESULTS: The majority (74%) of PN-only participants attended 6 or more sessions but only 28% attended 10 or more and 16% attended all eleven sessions. In contrast, 90% of PN + CM attended 6 or more visits, 69% attended 10 or more and 57% attended all eleven sessions (attendance distribution χ2[11] = 105.81; p < .0001). Overall (PN and PN + CM participants combined) percent with viral load suppression at 6-months was 15, 38 and 54% among those who attended 0-5, 6-9 and 10-11 visits, respectively (χ2(2) = 39.07, p < .001).

CONCLUSION: In this secondary post hoc analysis, contact with patient navigators was increased by attendance incentives. Higher rates of attendance at patient navigation sessions was associated with viral suppression at the 6-month follow-up assessment. Study results support use of attendance incentives to improve rates of contact between service providers and patients, particularly patients who are difficult to engage in care. Trial Registration clinicaltrials.govIdentifier: NCT01612169.

Original languageEnglish (US)
Number of pages1
JournalAddiction science & clinical practice
Volume12
Issue number1
DOIs
StatePublished - Jun 27 2017

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Patient Navigation
Viral Load
Motivation
HIV
Appointments and Schedules
Referral and Consultation

Keywords

  • Contingent incentives
  • HIV health care
  • HIV substance users
  • Patient navigation
  • Session attendance
  • Vial suppression

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Enhancing patient navigation to improve intervention session attendance and viral load suppression of persons with HIV and substance use : a secondary post hoc analysis of the Project HOPE study. / Stitzer, Maxine L; Matheson, Tim; Cunningham, Colin; Sorensen, James L.; Feaster, Daniel J.; Gooden, Lauren; Hammond, Alexis; Fitzsimons, Heather; Metsch, Lisa R.

In: Addiction science & clinical practice, Vol. 12, No. 1, 27.06.2017.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Interventions are needed to improve viral suppression rates among persons with HIV and substance use. A 3-arm randomized multi-site study (Metsch et al. in JAMA 316:156-70, 2016) was conducted to evaluate the effect on HIV outcomes of usual care referral to HIV and substance use services (N = 253) versus patient navigation delivered alone (PN: N = 266) or together with contingency management (PN + CM; N = 271) that provided financial incentives targeting potential behavioral mediators of viral load suppression.AIMS: This secondary analysis evaluates the effects of financial incentives on attendance at PN sessions and the relationship between session attendance and viral load suppression at end of the intervention.METHODS: Frequency of sessions attended was analyzed over time and by distribution of individual session attendance frequency (PN vs PN + CM). Percent virally suppressed (≤200 copies/mL) at 6 months was compared for low, medium and high rate attenders. In PN + CM a total of $220 could be earned for attendance at 11 PN sessions over the 6-month intervention with payments ranging from $10 to $30 under an escalating schedule.RESULTS: The majority (74{\%}) of PN-only participants attended 6 or more sessions but only 28{\%} attended 10 or more and 16{\%} attended all eleven sessions. In contrast, 90{\%} of PN + CM attended 6 or more visits, 69{\%} attended 10 or more and 57{\%} attended all eleven sessions (attendance distribution χ2[11] = 105.81; p < .0001). Overall (PN and PN + CM participants combined) percent with viral load suppression at 6-months was 15, 38 and 54{\%} among those who attended 0-5, 6-9 and 10-11 visits, respectively (χ2(2) = 39.07, p < .001).CONCLUSION: In this secondary post hoc analysis, contact with patient navigators was increased by attendance incentives. Higher rates of attendance at patient navigation sessions was associated with viral suppression at the 6-month follow-up assessment. Study results support use of attendance incentives to improve rates of contact between service providers and patients, particularly patients who are difficult to engage in care. Trial Registration clinicaltrials.govIdentifier: NCT01612169.",
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T2 - a secondary post hoc analysis of the Project HOPE study

AU - Stitzer, Maxine L

AU - Matheson, Tim

AU - Cunningham, Colin

AU - Sorensen, James L.

AU - Feaster, Daniel J.

AU - Gooden, Lauren

AU - Hammond, Alexis

AU - Fitzsimons, Heather

AU - Metsch, Lisa R.

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N2 - BACKGROUND: Interventions are needed to improve viral suppression rates among persons with HIV and substance use. A 3-arm randomized multi-site study (Metsch et al. in JAMA 316:156-70, 2016) was conducted to evaluate the effect on HIV outcomes of usual care referral to HIV and substance use services (N = 253) versus patient navigation delivered alone (PN: N = 266) or together with contingency management (PN + CM; N = 271) that provided financial incentives targeting potential behavioral mediators of viral load suppression.AIMS: This secondary analysis evaluates the effects of financial incentives on attendance at PN sessions and the relationship between session attendance and viral load suppression at end of the intervention.METHODS: Frequency of sessions attended was analyzed over time and by distribution of individual session attendance frequency (PN vs PN + CM). Percent virally suppressed (≤200 copies/mL) at 6 months was compared for low, medium and high rate attenders. In PN + CM a total of $220 could be earned for attendance at 11 PN sessions over the 6-month intervention with payments ranging from $10 to $30 under an escalating schedule.RESULTS: The majority (74%) of PN-only participants attended 6 or more sessions but only 28% attended 10 or more and 16% attended all eleven sessions. In contrast, 90% of PN + CM attended 6 or more visits, 69% attended 10 or more and 57% attended all eleven sessions (attendance distribution χ2[11] = 105.81; p < .0001). Overall (PN and PN + CM participants combined) percent with viral load suppression at 6-months was 15, 38 and 54% among those who attended 0-5, 6-9 and 10-11 visits, respectively (χ2(2) = 39.07, p < .001).CONCLUSION: In this secondary post hoc analysis, contact with patient navigators was increased by attendance incentives. Higher rates of attendance at patient navigation sessions was associated with viral suppression at the 6-month follow-up assessment. Study results support use of attendance incentives to improve rates of contact between service providers and patients, particularly patients who are difficult to engage in care. Trial Registration clinicaltrials.govIdentifier: NCT01612169.

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