Effectiveness of Peer Navigation and Contingency Management on Retention in HIV Care

University of California, Los Angeles579 enrolled

Overview

Consistent treatment with anti-retroviral therapy (ART) suppresses viral load (VL), prolonging life and improving quality of life for HIV+ persons. Suppressing VL benefits communities by reducing transmission to others. Mere availability of ART and care, however, is insufficient; the benefits of ART depend upon HIV+ persons' continuous visits to the health care provider, regular monitoring and regular delivery of medications, - known as retention in HIV care. In spite of national efforts, up to a quarter of HIV+ persons, especially low-income minorities are out of care. Innovative interventions are therefore urgently needed to maximize engagement and retention in HIV care, self-reported adherence, as well as HIV-1 RNA viral load suppression. In pursuit of these aims, the proposed study will assess outcomes of the following interventions in comparison to usual care: 1) contingency management (CM) only; 2) peer navigation (PN) only; and 3) a combined approach that integrates both CM and PN (CA) which the investigators hypothesize to be most effective in improving HIV clinical outcomes.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

579

Conditions

HIV/AIDS

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Diagnosed HIV+ 2. Age 18 years or older 3. English or Spanish speaking 4. Residence in Los Angeles County 5. prescribed ART in prior 24 months 6. \< 3 visits in prior 12 months or have detectable viral load, as identified in the Ryan White CaseWatch database Exclusion Criteria: Not meeting any of the criteria identified above

Locations (6)

Center for Health Justice

Los Angeles, California, United States

Los Angeles Sheriff's Department

Los Angeles, California, United States

AltaMed Health Services Corporation

Los Angeles, California, United States

Oasis Clinic

Los Angeles, California, United States

Olive View Medical Center

Sylmar, California, United States

Northeast Valley Health Corporation

Van Nuys, California, United States

Outcomes

Primary Outcomes

Change in retention-in-care behaviors over 12 months

Using a 2x2 factorial design, to examine the effect of the three interventions -- peer navigation, contingency management, combined approach and usual care -- and evaluate how well they improve retention in HIV care

Time frame: Basline, follow-ups at month 2, 6, 12

Change in HIV RNA viral load suppression and medication adherence over 12 months

Using the same design, to examine the effects of the PN, CM and, CA interventions on HIV RNA viral load suppression and self-reported adherence

Time frame: Basline, follow-ups at month 2, and 12

Secondary Outcomes

Cost effectiveness

A secondary aim is to examine the cost-offset and potential cost-effectiveness of each intervention compared with usual care

Time frame: 5 years