Journal article
Effect of Patient Navigation With or Without Financial Incentives on Viral Suppression Among Hospitalized Patients With HIV Infection and Substance Use: A Randomized Clinical Trial
JAMA : the journal of the American Medical Association, v 316(2), pp 156-170
12 Jul 2016
PMID: 27404184
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Substance use is a major driver of the HIV epidemic and is associated with poor HIV care outcomes. Patient navigation (care coordination with case management) and the use of financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance use disorders treatment and HIV care, but there is little evidence for their efficacy in improving HIV-1 viral suppression rates.
To assess the effect of a structured patient navigation intervention with or without financial incentives to improve HIV-1 viral suppression rates among patients with elevated HIV-1 viral loads and substance use recruited as hospital inpatients.
From July 2012 through January 2014, 801 patients with HIV infection and substance use from 11 hospitals across the United States were randomly assigned to receive patient navigation alone (n = 266), patient navigation plus financial incentives (n = 271), or treatment as usual (n = 264). HIV-1 plasma viral load was measured at baseline and at 6 and 12 months.
Patient navigation included up to 11 sessions of care coordination with case management and motivational interviewing techniques over 6 months. Financial incentives (up to $1160) were provided for achieving targeted behaviors aimed at reducing substance use, increasing engagement in HIV care, and improving HIV outcomes. Treatment as usual was the standard practice at each hospital for linking hospitalized patients to outpatient HIV care and substance use disorders treatment.
The primary outcome was HIV viral suppression (≤200 copies/mL) relative to viral nonsuppression or death at the 12-month follow-up.
Of 801 patients randomized, 261 (32.6%) were women (mean [SD] age, 44.6 years [10.0 years]). There were no differences in rates of HIV viral suppression versus nonsuppression or death among the 3 groups at 12 months. Eighty-five of 249 patients (34.1%) in the usual-treatment group experienced treatment success compared with 89 of 249 patients (35.7%) in the navigation-only group for a treatment difference of 1.6% (95% CI, -6.8% to 10.0%; P = .80) and compared with 98 of 254 patients (38.6%) in the navigation-plus-incentives group for a treatment difference of 4.5% (95% CI -4.0% to 12.8%; P = .68). The treatment difference between the navigation-only and the navigation-plus-incentives group was -2.8% (95% CI, -11.3% to 5.6%; P = .68).
Among hospitalized patients with HIV infection and substance use, patient navigation with or without financial incentives did not have a beneficial effect on HIV viral suppression relative to nonsuppression or death at 12 months vs treatment as usual. These findings do not support these interventions in this setting.
clinicaltrials.gov Identifier: NCT01612169.
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Details
- Title
- Effect of Patient Navigation With or Without Financial Incentives on Viral Suppression Among Hospitalized Patients With HIV Infection and Substance Use: A Randomized Clinical Trial
- Creators
- Lisa R Metsch - Columbia UniversityDaniel J Feaster - University of MiamiLauren Gooden - Columbia UniversityTim Matheson - San Francisco Department of Public HealthMaxine Stitzer - Johns Hopkins MedicineMoupali Das - San Francisco General HospitalMamta K Jain - The University of Texas Southwestern Medical CenterAllan E Rodriguez - University of MiamiWendy S Armstrong - Emory UniversityGregory M Lucas - Johns Hopkins MedicineAnk E Nijhawan - The University of Texas Southwestern Medical CenterMari-Lynn Drainoni - Boston UniversityPatricia Herrera - Ruth M. Rothstein CORE CenterPamela Vergara-Rodriguez - Ruth M. Rothstein CORE CenterJeffrey M Jacobson - Drexel UniversityMichael J Mugavero - University of Alabama at BirminghamMeg Sullivan - Boston UniversityEric S Daar - The Lundquist InstituteDeborah K McMahon - University of PittsburghDavid C Ferris - Icahn School of Medicine at Mount SinaiRobert Lindblad - Emmes CorporationPaul VanVeldhuisen - Emmes CorporationNeal Oden - Emmes CorporationPedro C Castellón - Columbia UniversitySusan Tross - Columbia University Irving Medical CenterLouise F Haynes - Medical University of South CarolinaAntoine Douaihy - University of PittsburghJames L Sorensen - North Central Cancer Treatment GroupDavid S Metzger - University of PennsylvaniaRaul N Mandler - National Institute on Drug AbuseGrant N Colfax - San Francisco Department of Public HealthCarlos del Rio - Emory University
- Publication Details
- JAMA : the journal of the American Medical Association, v 316(2), pp 156-170
- Publisher
- American Medical Association
- Grant note
- U10DA013727 / NIDA NIH HHS UG1 DA013034 / NIDA NIH HHS U10DA013045 / NIDA NIH HHS P30AI073961 / NIAID NIH HHS UG1DA013035 / NIDA NIH HHS HHSN271200900034C/N01DA92217 / NIDA NIH HHS UG1DA015831 / NIDA NIH HHS UG1DA013034 / NIDA NIH HHS P30AI050409 / NIAID NIH HHS UG1 DA013035 / NIDA NIH HHS HHSN271200900034C / NIDA NIH HHS HHSN271201400028C / NIDA NIH HHS U10 DA013045 / NIDA NIH HHS UG1 DA015831 / NIDA NIH HHS UG1DA013732 / NIDA NIH HHS U10DA013720 / NIDA NIH HHS P30 AI050409 / NIAID NIH HHS U10DA020024 / NIDA NIH HHS UL1 TR000454 / NCATS NIH HHS UG1 DA013732 / NIDA NIH HHS U10 DA015831 / NIDA NIH HHS P30MH043520 / NIMH NIH HHS U10 DA013035 / NIDA NIH HHS U10 DA020036 / NIDA NIH HHS U10 DA013043 / NIDA NIH HHS U10 DA013732 / NIDA NIH HHS P30 MH043520 / NIMH NIH HHS UL1TR000454 / NCATS NIH HHS K24 DA035684 / NIDA NIH HHS HHSN271201000024C/N01DA102221 / NIDA NIH HHS UG1 DA013727 / NIDA NIH HHS U10DA015815 / NIDA NIH HHS U10DA013034 / NIDA NIH HHS UG1DA013727 / NIDA NIH HHS P30 AI073961 / NIAID NIH HHS UG1DA020024 / NIDA NIH HHS U10 DA013034 / NIDA NIH HHS UG1DA013720 / NIDA NIH HHS U10DA013043 / NIDA NIH HHS U10DA020036 / NIDA NIH HHS UG1 DA013720 / NIDA NIH HHS UG1 DA020024 / NIDA NIH HHS UG1DA015815 / NIDA NIH HHS U10 DA020024 / NIDA NIH HHS HHSN271201000024C / NIDA NIH HHS HHSN271201400028C/N01DA142237 / NIDA NIH HHS U10DA013035 / NIDA NIH HHS UG1 DA015815 / NIDA NIH HHS U10 DA013727 / NIDA NIH HHS U10 DA015815 / NIDA NIH HHS U10DA015831 / NIDA NIH HHS U10 DA013720 / NIDA NIH HHS U10DA013732 / NIDA NIH HHS
- Resource Type
- Journal article
- Language
- English
- Web of Science ID
- WOS:000379509000012
- Scopus ID
- 2-s2.0-84978372619
- Other Identifier
- 991019335320404721
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- Collaboration types
- Industry collaboration
- Domestic collaboration
- Web of Science research areas
- Infectious Diseases