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Enhancing Patient Navigation to Improve Intervention Session Attendance and Viral Load Suppression of Persons with HIV and Substance Use: A Secondary Post Hoc Analysis of the Project HOPE Study.

Addiction Science & Clinical Practice 2017;12:16. [doi: 10.1186/s13722-017-0081-1]

Maxine L. Stitzer, PhD (Johns Hopkins University, MA Node), Tim Matheson, PhD (San Francisco Dept. of Public Health, WS Node), Colin Cunningham, PhD (Johns Hopkins University, MA Node), James L. Sorensen, PhD (San Francisco General Hospital, WS Node), Lauren K. Gooden, PhD, MPH (University of Miami, Columbia University, FNA Node), Alexis S. Hammond, MD, PhD (Johns Hopkins University, MA Node), Heather Fitzsimons, MPH, CCRP (Johns Hopkins University, MA Node), Lisa R. Metsch, PhD (Columbia University, FNA Node).

Interventions are needed to improve viral suppression rates among persons with HIV and substance use. A 3-arm randomized multi-site study (CTN-0049, Project HOPE) 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. 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 the end of the intervention.

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.

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. 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.

Conclusion: In this secondary post hoc analysis, contact with patient negotiators 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. (Article (Peer-Reviewed), PDF, English, 2017)

Keywords: Case management | Contingency management (CM) | CTN platform/ancillary study | Motivational incentives | HIV/AIDS | Retention - Treatment | Addiction Science & Clinical Practice (journal)

Document No: 1274, PMID: 28651612, PMCID: PMC5485550.

Submitted by the CTN Dissemination Librarians (7/7/2017).

Cunningham, Colin
Feaster, Daniel J. mail
Fitzsimons, Heather mail
Gooden, Lauren K. mail
Hammond, Alexis S. mail
Matheson, Tim mail
Metsch, Lisa R. search mail
Sorensen, James L. mail
Stitzer, Maxine L. mail
NIDA-CTN-0049 www

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Supported by a grant from the National Institute on Drug Abuse to the University of Washington Alcohol and Drug Abuse Institute.
The materials on this site have neither been created nor reviewed by NIDA.
Updated 9/2017 --
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