Effect of Patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use a randomized clinical trial

Lisa R. Metsch, Daniel J. Feaster, Lauren Gooden, Tim Matheson, Maxine Stitzer, Moupali Das, Mamta K. Jain, Allan E. Rodriguez, Wendy S. Armstrong, Gregory M. Lucas, Ank E. Nijhawan, Mari Lynn Drainoni, Patricia Herrera, Pamela Vergara-Rodriguez, Jeffrey M. Jacobson, Michael J. Mugavero, Meg Sullivan, Eric S. Daar, Deborah K. McMahon, David C. Ferris & 12 others Robert Lindblad, Paul Van Veldhuisen, Neal Oden, Pedro C. Castellón, Susan Tross, Louise F. Haynes, Antoine Douaihy, James L. Sorensen, David S. Metzger, Raul N. Mandler, Grant N. Colfax, Carlos Del Rio

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

IMPORTANCE: Substance use is a major driver of the HIVepidemicand is associated with poor HIV care outcomes. Patient navigation (care coordination with case management) and the use of financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance use disorders treatment and HIV care, but there is little evidence for their efficacy in improving HIV-1 viral suppression rates. OBJECTIVE: To assess the effect of a structured patient navigation intervention with or without financial incentives to improve HIV-1 viral suppression rates among patients with elevated HIV-1 viral loads and substance use recruited as hospital inpatients. DESIGN, SETTING, AND PARTICIPANTS: From July 2012 through January 2014, 801 patients with HIV infection and substance use from 11 hospitals across the United States were randomly assigned to receive patient navigation alone (n = 266), patient navigation plus financial incentives (n = 271), or treatment as usual (n = 264). HIV-1 plasma viral load was measured at baseline and at 6 and 12 months. INTERVENTIONS: Patient navigation included up to 11 sessions of care coordination with case management and motivational interviewing techniques over 6 months. Financial incentives (up to $1160) were provided for achieving targeted behaviors aimed at reducing substance use, increasing engagement in HIV care, and improving HIV outcomes. Treatment as usual was the standard practice at each hospital for linking hospitalized patients to outpatient HIV care and substance use disorders treatment. MAIN OUTCOMES AND MEASURES: The primary outcome was HIV viral suppression (≤200 copies/mL) relative to viral nonsuppression or death at the 12-month follow-up. RESULTS: Of 801 patients randomized, 261 (32.6%) were women (mean [SD] age, 44.6 years [10.0 years]). There were no differences in rates of HIV viral suppression versus nonsuppression or death among the 3 groups at 12 months. Eighty-five of 249 patients (34.1%) in the usual-treatment group experienced treatment success compared with 89 of 249 patients (35.7%) in the navigation-only group for a treatment difference of 1.6% (95% CI, -6.8% to 10.0%; P =.80) and compared with 98 of 254 patients (38.6%) in the navigation-plus-incentives group for a treatment difference of 4.5% (95% CI -4.0% to 12.8%; P =.68). The treatment difference between the navigation-only and the navigation-plus-incentives group was -2.8% (95% CI, -11.3% to 5.6%; P =.68). CONCLUSIONS AND RELEVANCE: Among hospitalized patients with HIV infection and substance use, patient navigation with or without financial incentives did not have a beneficial effect on HIV viral suppression relative to nonsuppression or death at 12 months vs treatment as usual. These findings do not support these interventions in this setting.

Original languageEnglish (US)
Pages (from-to)156-170
Number of pages15
JournalJAMA - Journal of the American Medical Association
Volume316
Issue number2
DOIs
StatePublished - Jul 12 2016

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Patient Navigation
HIV Infections
Motivation
Randomized Controlled Trials
HIV
HIV-1
Therapeutics
Case Management
Viral Load
Substance-Related Disorders
Motivational Interviewing
Ambulatory Care
Inpatients
Patient Care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Effect of Patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use a randomized clinical trial. / Metsch, Lisa R.; Feaster, Daniel J.; Gooden, Lauren; Matheson, Tim; Stitzer, Maxine; Das, Moupali; Jain, Mamta K.; Rodriguez, Allan E.; Armstrong, Wendy S.; Lucas, Gregory M.; Nijhawan, Ank E.; Drainoni, Mari Lynn; Herrera, Patricia; Vergara-Rodriguez, Pamela; Jacobson, Jeffrey M.; Mugavero, Michael J.; Sullivan, Meg; Daar, Eric S.; McMahon, Deborah K.; Ferris, David C.; Lindblad, Robert; Van Veldhuisen, Paul; Oden, Neal; Castellón, Pedro C.; Tross, Susan; Haynes, Louise F.; Douaihy, Antoine; Sorensen, James L.; Metzger, David S.; Mandler, Raul N.; Colfax, Grant N.; Del Rio, Carlos.

In: JAMA - Journal of the American Medical Association, Vol. 316, No. 2, 12.07.2016, p. 156-170.

Research output: Contribution to journalArticle

Metsch, LR, Feaster, DJ, Gooden, L, Matheson, T, Stitzer, M, Das, M, Jain, MK, Rodriguez, AE, Armstrong, WS, Lucas, GM, Nijhawan, AE, Drainoni, ML, Herrera, P, Vergara-Rodriguez, P, Jacobson, JM, Mugavero, MJ, Sullivan, M, Daar, ES, McMahon, DK, Ferris, DC, Lindblad, R, Van Veldhuisen, P, Oden, N, Castellón, PC, Tross, S, Haynes, LF, Douaihy, A, Sorensen, JL, Metzger, DS, Mandler, RN, Colfax, GN & Del Rio, C 2016, 'Effect of Patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use a randomized clinical trial', JAMA - Journal of the American Medical Association, vol. 316, no. 2, pp. 156-170. https://doi.org/10.1001/jama.2016.8914
Metsch, Lisa R. ; Feaster, Daniel J. ; Gooden, Lauren ; Matheson, Tim ; Stitzer, Maxine ; Das, Moupali ; Jain, Mamta K. ; Rodriguez, Allan E. ; Armstrong, Wendy S. ; Lucas, Gregory M. ; Nijhawan, Ank E. ; Drainoni, Mari Lynn ; Herrera, Patricia ; Vergara-Rodriguez, Pamela ; Jacobson, Jeffrey M. ; Mugavero, Michael J. ; Sullivan, Meg ; Daar, Eric S. ; McMahon, Deborah K. ; Ferris, David C. ; Lindblad, Robert ; Van Veldhuisen, Paul ; Oden, Neal ; Castellón, Pedro C. ; Tross, Susan ; Haynes, Louise F. ; Douaihy, Antoine ; Sorensen, James L. ; Metzger, David S. ; Mandler, Raul N. ; Colfax, Grant N. ; Del Rio, Carlos. / Effect of Patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use a randomized clinical trial. In: JAMA - Journal of the American Medical Association. 2016 ; Vol. 316, No. 2. pp. 156-170.
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abstract = "IMPORTANCE: Substance use is a major driver of the HIVepidemicand is associated with poor HIV care outcomes. Patient navigation (care coordination with case management) and the use of financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance use disorders treatment and HIV care, but there is little evidence for their efficacy in improving HIV-1 viral suppression rates. OBJECTIVE: To assess the effect of a structured patient navigation intervention with or without financial incentives to improve HIV-1 viral suppression rates among patients with elevated HIV-1 viral loads and substance use recruited as hospital inpatients. DESIGN, SETTING, AND PARTICIPANTS: From July 2012 through January 2014, 801 patients with HIV infection and substance use from 11 hospitals across the United States were randomly assigned to receive patient navigation alone (n = 266), patient navigation plus financial incentives (n = 271), or treatment as usual (n = 264). HIV-1 plasma viral load was measured at baseline and at 6 and 12 months. INTERVENTIONS: Patient navigation included up to 11 sessions of care coordination with case management and motivational interviewing techniques over 6 months. Financial incentives (up to $1160) were provided for achieving targeted behaviors aimed at reducing substance use, increasing engagement in HIV care, and improving HIV outcomes. Treatment as usual was the standard practice at each hospital for linking hospitalized patients to outpatient HIV care and substance use disorders treatment. MAIN OUTCOMES AND MEASURES: The primary outcome was HIV viral suppression (≤200 copies/mL) relative to viral nonsuppression or death at the 12-month follow-up. RESULTS: Of 801 patients randomized, 261 (32.6{\%}) were women (mean [SD] age, 44.6 years [10.0 years]). There were no differences in rates of HIV viral suppression versus nonsuppression or death among the 3 groups at 12 months. Eighty-five of 249 patients (34.1{\%}) in the usual-treatment group experienced treatment success compared with 89 of 249 patients (35.7{\%}) in the navigation-only group for a treatment difference of 1.6{\%} (95{\%} CI, -6.8{\%} to 10.0{\%}; P =.80) and compared with 98 of 254 patients (38.6{\%}) in the navigation-plus-incentives group for a treatment difference of 4.5{\%} (95{\%} CI -4.0{\%} to 12.8{\%}; P =.68). The treatment difference between the navigation-only and the navigation-plus-incentives group was -2.8{\%} (95{\%} CI, -11.3{\%} to 5.6{\%}; P =.68). CONCLUSIONS AND RELEVANCE: Among hospitalized patients with HIV infection and substance use, patient navigation with or without financial incentives did not have a beneficial effect on HIV viral suppression relative to nonsuppression or death at 12 months vs treatment as usual. These findings do not support these interventions in this setting.",
author = "Metsch, {Lisa R.} and Feaster, {Daniel J.} and Lauren Gooden and Tim Matheson and Maxine Stitzer and Moupali Das and Jain, {Mamta K.} and Rodriguez, {Allan E.} and Armstrong, {Wendy S.} and Lucas, {Gregory M.} and Nijhawan, {Ank E.} and Drainoni, {Mari Lynn} and Patricia Herrera and Pamela Vergara-Rodriguez and Jacobson, {Jeffrey M.} and Mugavero, {Michael J.} and Meg Sullivan and Daar, {Eric S.} and McMahon, {Deborah K.} and Ferris, {David C.} and Robert Lindblad and {Van Veldhuisen}, Paul and Neal Oden and Castell{\'o}n, {Pedro C.} and Susan Tross and Haynes, {Louise F.} and Antoine Douaihy and Sorensen, {James L.} and Metzger, {David S.} and Mandler, {Raul N.} and Colfax, {Grant N.} and {Del Rio}, Carlos",
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T1 - Effect of Patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use a randomized clinical trial

AU - Metsch, Lisa R.

AU - Feaster, Daniel J.

AU - Gooden, Lauren

AU - Matheson, Tim

AU - Stitzer, Maxine

AU - Das, Moupali

AU - Jain, Mamta K.

AU - Rodriguez, Allan E.

AU - Armstrong, Wendy S.

AU - Lucas, Gregory M.

AU - Nijhawan, Ank E.

AU - Drainoni, Mari Lynn

AU - Herrera, Patricia

AU - Vergara-Rodriguez, Pamela

AU - Jacobson, Jeffrey M.

AU - Mugavero, Michael J.

AU - Sullivan, Meg

AU - Daar, Eric S.

AU - McMahon, Deborah K.

AU - Ferris, David C.

AU - Lindblad, Robert

AU - Van Veldhuisen, Paul

AU - Oden, Neal

AU - Castellón, Pedro C.

AU - Tross, Susan

AU - Haynes, Louise F.

AU - Douaihy, Antoine

AU - Sorensen, James L.

AU - Metzger, David S.

AU - Mandler, Raul N.

AU - Colfax, Grant N.

AU - Del Rio, Carlos

PY - 2016/7/12

Y1 - 2016/7/12

N2 - IMPORTANCE: Substance use is a major driver of the HIVepidemicand is associated with poor HIV care outcomes. Patient navigation (care coordination with case management) and the use of financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance use disorders treatment and HIV care, but there is little evidence for their efficacy in improving HIV-1 viral suppression rates. OBJECTIVE: To assess the effect of a structured patient navigation intervention with or without financial incentives to improve HIV-1 viral suppression rates among patients with elevated HIV-1 viral loads and substance use recruited as hospital inpatients. DESIGN, SETTING, AND PARTICIPANTS: From July 2012 through January 2014, 801 patients with HIV infection and substance use from 11 hospitals across the United States were randomly assigned to receive patient navigation alone (n = 266), patient navigation plus financial incentives (n = 271), or treatment as usual (n = 264). HIV-1 plasma viral load was measured at baseline and at 6 and 12 months. INTERVENTIONS: Patient navigation included up to 11 sessions of care coordination with case management and motivational interviewing techniques over 6 months. Financial incentives (up to $1160) were provided for achieving targeted behaviors aimed at reducing substance use, increasing engagement in HIV care, and improving HIV outcomes. Treatment as usual was the standard practice at each hospital for linking hospitalized patients to outpatient HIV care and substance use disorders treatment. MAIN OUTCOMES AND MEASURES: The primary outcome was HIV viral suppression (≤200 copies/mL) relative to viral nonsuppression or death at the 12-month follow-up. RESULTS: Of 801 patients randomized, 261 (32.6%) were women (mean [SD] age, 44.6 years [10.0 years]). There were no differences in rates of HIV viral suppression versus nonsuppression or death among the 3 groups at 12 months. Eighty-five of 249 patients (34.1%) in the usual-treatment group experienced treatment success compared with 89 of 249 patients (35.7%) in the navigation-only group for a treatment difference of 1.6% (95% CI, -6.8% to 10.0%; P =.80) and compared with 98 of 254 patients (38.6%) in the navigation-plus-incentives group for a treatment difference of 4.5% (95% CI -4.0% to 12.8%; P =.68). The treatment difference between the navigation-only and the navigation-plus-incentives group was -2.8% (95% CI, -11.3% to 5.6%; P =.68). CONCLUSIONS AND RELEVANCE: Among hospitalized patients with HIV infection and substance use, patient navigation with or without financial incentives did not have a beneficial effect on HIV viral suppression relative to nonsuppression or death at 12 months vs treatment as usual. These findings do not support these interventions in this setting.

AB - IMPORTANCE: Substance use is a major driver of the HIVepidemicand is associated with poor HIV care outcomes. Patient navigation (care coordination with case management) and the use of financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance use disorders treatment and HIV care, but there is little evidence for their efficacy in improving HIV-1 viral suppression rates. OBJECTIVE: To assess the effect of a structured patient navigation intervention with or without financial incentives to improve HIV-1 viral suppression rates among patients with elevated HIV-1 viral loads and substance use recruited as hospital inpatients. DESIGN, SETTING, AND PARTICIPANTS: From July 2012 through January 2014, 801 patients with HIV infection and substance use from 11 hospitals across the United States were randomly assigned to receive patient navigation alone (n = 266), patient navigation plus financial incentives (n = 271), or treatment as usual (n = 264). HIV-1 plasma viral load was measured at baseline and at 6 and 12 months. INTERVENTIONS: Patient navigation included up to 11 sessions of care coordination with case management and motivational interviewing techniques over 6 months. Financial incentives (up to $1160) were provided for achieving targeted behaviors aimed at reducing substance use, increasing engagement in HIV care, and improving HIV outcomes. Treatment as usual was the standard practice at each hospital for linking hospitalized patients to outpatient HIV care and substance use disorders treatment. MAIN OUTCOMES AND MEASURES: The primary outcome was HIV viral suppression (≤200 copies/mL) relative to viral nonsuppression or death at the 12-month follow-up. RESULTS: Of 801 patients randomized, 261 (32.6%) were women (mean [SD] age, 44.6 years [10.0 years]). There were no differences in rates of HIV viral suppression versus nonsuppression or death among the 3 groups at 12 months. Eighty-five of 249 patients (34.1%) in the usual-treatment group experienced treatment success compared with 89 of 249 patients (35.7%) in the navigation-only group for a treatment difference of 1.6% (95% CI, -6.8% to 10.0%; P =.80) and compared with 98 of 254 patients (38.6%) in the navigation-plus-incentives group for a treatment difference of 4.5% (95% CI -4.0% to 12.8%; P =.68). The treatment difference between the navigation-only and the navigation-plus-incentives group was -2.8% (95% CI, -11.3% to 5.6%; P =.68). CONCLUSIONS AND RELEVANCE: Among hospitalized patients with HIV infection and substance use, patient navigation with or without financial incentives did not have a beneficial effect on HIV viral suppression relative to nonsuppression or death at 12 months vs treatment as usual. These findings do not support these interventions in this setting.

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