Patient Navigation Programs Increase Viral Suppression Rates Among Patients With HIV

Patient navigation interventions in five US states were linked with gains in the number of patients engaged in human immunodeficiency virus (HIV) care and the proportion achieving viral suppression, according to a study published in PLOS Medicine.  

“The patient navigation-type interventions implemented in these five demonstration states substantially improved HIV care continuum targets over the first year of implementation,” researchers wrote. “The cost per outcome of these interventions was better than or similar to previous patient navigation interventions.” 

The study looked at patient navigation demonstration programs for people with HIV funded by the Health Resources and Services Administration’s Special Projects of National Significance Program in five states: Louisiana, Massachusetts, North Carolina, Virginia, and Wisconsin. The programs focused on people with HIV who had never entered HIV care, had fallen out of care, or were at risk of falling out of care. 

Some 3443 patients, three quarters of whom were male, were enrolled in the programs. Among them, 24% were newly diagnosed, 2% had never been in HIV care, 45% had fallen out of care, and 29% were at risk of falling out of care.

In each state, the patient navigation intervention was associated with improvements in patient engagement and HIV viral suppression, according to the study. The proportion of patients with viral suppression increased 90.9% in Louisiana, 78.1% in Massachusetts, 47.5% in North Carolina, 54.6% in Virginia, and 58.4% in Wisconsin. 

Per the outcome of additional patient virally suppressed, costs were lowest in North Carolina ($920), researchers found. Patient navigation intervention costs per outcome were $2009 in Massachusetts, $2212 in Virginia, $3700 in Wisconsin, and $4415 in Louisiana. 

“Cost per outcome was minimized in states that utilized surveillance data to identify individuals who were out of care and/or those that were able to identify a larger number of patients in need of improvement at baseline,” researchers noted. 

Reference: 

Shade SB, Kirby VB, Stephens S, et al. Outcomes and costs of publicly funded patient navigation interventions to enhance HIV care continuum outcomes in the United States: A before-and-after study. PLoS Med. 2021;18(5):e1003418. Published 2021 May 13. doi:10.1371/journal.pmed.1003418