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Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2017

Open Access 01-12-2017 | Research

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

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

Published in: Addiction Science & Clinical Practice | Issue 1/2017

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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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Metadata
Title
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
Authors
Maxine Stitzer
Tim Matheson
Colin Cunningham
James L. Sorensen
Daniel J. Feaster
Lauren Gooden
Alexis S. Hammond
Heather Fitzsimons
Lisa R. Metsch
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2017
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-017-0081-1

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