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

Not Applicable

Completed

Interventions: Behavioral: Contingency Management
Behavioral: Peer Navigation
Behavioral: Combined Contingency Management and Peer Navigation

Brief Summary: 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.

Recruitment & Eligibility

Inclusion Criteria

Diagnosed HIV+
Age 18 years or older
English or Spanish speaking
Residence in Los Angeles County
prescribed ART in prior 24 months
< 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

Arm && Interventions

Group	Intervention	Description
Contingency Management only	Contingency Management	Participants assigned to this arm will receive payments for attending regular HIV medical appointments at the clinic and filling prescribed HIV medications at the pharmacy
Peer Navigation only	Peer Navigation	Participants in this arm will be assigned a peer navigator to assist them in accessing and remaining in HIV care
Combined Contingency Management and Peer Navigation	Combined Contingency Management and Peer Navigation	Participants in this arm will be assigned a peer navigator to assist them in accessing and remaining in HIV care and will be eligible to receive incentives for attending HIV care visits/refilling prescriptions.

Primary Outcome Measures

Name	Time	Method
Change in HIV RNA viral load suppression and medication adherence over 12 months	Basline, follow-ups at month 2, and 12	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
Change in retention-in-care behaviors over 12 months	Basline, follow-ups at month 2, 6, 12	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

Secondary Outcome Measures

Name	Time	Method
Cost effectiveness	5 years	A secondary aim is to examine the cost-offset and potential cost-effectiveness of each intervention compared with usual care

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
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Sylmar, California, United States
Northeast Valley Health Corporation
🇺🇸
Van Nuys, California, United States