Implementation and Operational Research: The Navigation Program: An Intervention to Reengage Lost Patients at 7 HIV Clinics in Los Angeles County, 20122014

Wohl, Amy Rock MPH, PhD*; Dierst-Davies, Rhodri MPH, PhD*; Victoroff, Alla MPH, PA*; James, Saloniki MA*; Bendetson, Jesse BA*; Bailey, Jeff MPH; Daar, Eric MD; Spencer, LaShonda MD§; Kulkarni, Sonali MD, MPH*; Pérez, Mario J. MPH*

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 February 2016 - Volume 71 - Issue 2 - p e44–e50
doi: 10.1097/QAI.0000000000000871
Epidemiology and Prevention

Abstract: The Navigation Program is a health department-community agency collaboration to reengage lost HIV clinic patients in Los Angeles County using best practices from disease investigator services locator activities and the Antiretroviral Treatment Access Study (ARTAS), a CDC-recommended intervention. Clinic databases were reviewed to identify HIV patients who: (1) had no HIV care visits in 6–12 months and last viral load was greater than 200 copies per milliliter; (2) had no HIV care visits in >12 months; (3) were newly diagnosed and never in care; or (4) were recently released from jail/prison/other institution with no regular HIV medical provider. Patients were contacted by trained Navigators using locator information from clinic medical records, HIV/sexually transmitted disease surveillance, and people-finder databases and offered enrollment in a modified ARTAS intervention. Among the 1139 lost clinic patients identified, 36% were in care elsewhere, 29% could not be located, 8% returned to the clinic independently, 4% declined enrollment, and 7% (n = 78) were located and enrolled in the intervention. Participants received an average of 4.5 Navigator sessions over 11.6 hours. Among reengaged patients, 68% linked within 3 months, 85% linked within 6 months, and 94% linked within 12 months, and 82% of linked patients were retained in care 12 months after study enrollment. The percentage of linked patients virally suppressed was compared at time of linkage by the Navigators (52%) with a second viral load measure after linkage to care (63%) (χ2 = 11.8; P = 0.01). The combined disease investigator services/ARTAS model of reengagement was effective for locating and reengaging lost HIV clinic patients. Access to HIV surveillance data is critical for the efficient identification of persons truly in need of reengagement.

*Division of HIV and STD Programs, Los Angeles County Department of Public Health;

Client Services, AIDS Project Los Angeles (APLA);

Division of Medicine, Harbor-UCLA Medical Center; and

§Division of Infectious Diseases, LAC-USC Medical Center.

Correspondence to: Amy Rock Wohl, MPH, PhD, Division of HIV and STD Programs, Los Angeles County Department of Public Health, 600 S. Commonwealth Avenue, Suite 1920, Los Angeles, CA 90005 (e-mail: awohl@ph.lacounty.gov).

Supported by CDC; AIDS United. Supported partially by the Social Innovation Fund (SIF), a program of the Corporation for National and Community Service (CNCS). The Social Innovation Fund combines public and private resources to grow the impact of innovative, community-based solutions that have compelling evidence of improving the lives of people in low-income communities throughout the United States. The SIF invests in 3 priority areas: economic opportunity, healthy futures, and youth development.

Presented at IAPAC, June 2014, Miami, FL; APHA, November 2014, New Orleans, LA.

E. Daar is a consultant and receives research support from Bristol Myers Squibb, Gilead, Merck, and ViiV; consultant for Abbvie, Janssen, and Teva. The remaining authors have no funding or conflicts of interest to disclose.

Received April 24, 2015

Accepted September 25, 2015

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