Differential Effects of Patient Navigation across Latent Profiles of Barriers to Care among People Living with HIV and Comorbid Conditions

• Type of Material: Article
• Authors: Sharleen M Traynor, Durham Technical Community College; Renae D Schmidt, University of Miami; Lauren K Gooden, Columbia University; Tim Matheson, Center on Substance Use and Health; Louise Haynes, Medical University of South Carolina; Allan Rodriguez, University of Miami; Michael Mugavero, University of Alabama Birmingham; Petra Jacobs, National Institute on Drug Abuse, Rockville; Raul Mandler, National Institute on Drug Abuse, Rockville; Carlos Del Rio, Emory University; Adam WW Carrico, University of Miami; Viviana EE Horigian, University of Miami; Lisa RR Metsch, Columbia University; Daniel JJ Feaster, University of Miami
• Language: English
• Date: 2023-01-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2022 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/jcm12010114
• Title of Journal or Parent Work: JOURNAL OF CLINICAL MEDICINE
• Volume: 12
• Issue: 1
• Grant/Funding Information: This work was supported by the National Institutes on Drug Abuse [U10DA013720 and UG1DA013720], the Miami CFAR [P30AI073961], the Emory Center for AIDS Research [P30AI050409] and the Center for HIV and Research in Mental Health [P30MH116867].
• Keywords: HEALTH; SUBSTANCE-ABUSE; barriers to care; INTIMATE PARTNER VIOLENCE; syndemic framework; CASE-MANAGEMENT INTERVENTION; Medicine, General & Internal; substance use; SOCIAL SUPPORT; Life Sciences & Biomedicine; ENGAGEMENT; PSYCHOMETRIC PROPERTIES; patient navigation; MEDICAL-CARE; General & Internal Medicine; social determinants of health; HIV; Science & Technology; DRUG-ABUSE; co-occurring disorders; VIRAL LOAD
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Mental Health

Abstract

Engaging people living with HIV who report substance use (PLWH-SU) in care is essential to HIV medical management and prevention of new HIV infections. Factors associated with poor engagement in HIV care include a combination of syndemic psychosocial factors, mental and physical comorbidities, and structural barriers to healthcare utilization. Patient navigation (PN) is designed to reduce barriers to care, but its effectiveness among PLWH-SU remains unclear. We analyzed data from NIDA Clinical Trials Network’s CTN-0049, a three-arm randomized controlled trial testing the effect of a 6-month PN with and without contingency management (CM), on engagement in HIV care and viral suppression among PLWH-SU (n = 801). Latent profile analysis was used to identify subgroups of individuals’ experiences to 23 barriers to care. The effects of PN on engagement in care and viral suppression were compared across latent profiles. Three latent profiles of barriers to care were identified. The results revealed that PN interventions are likely to be most effective for PLWH-SU with fewer, less severe healthcare barriers. Special attention should be given to individuals with a history of abuse, intimate partner violence, and discrimination, as they may be less likely to benefit from PN alone and require additional interventions.