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标题：The Effect of Patient Navigation on the Likelihood of Engagement in Clinical Care for HIV-Infected Individuals Leaving Jail
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作者：Janet J. Myers ; Mi-Suk Kang Dufour ; Kimberly A. Koester 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2018
卷号：108
期号：3
页码：385-392
DOI：10.2105/AJPH.2017.304250
语种：English
出版社：American Public Health Association
摘要：Objectives. To compare the effectiveness of patient navigation–enhanced case management in supporting engagement in HIV care upon release from jail relative to existing services. Methods. We randomized 270 HIV-infected individuals to receive navigation-enhanced case management for 12 months or standard case management for 90 days following release from jail between 2010 and 2013. Participants were interviewed at 2, 6, and 12 months after release. We abstracted medical data from jail and city health records. Results. Patient navigation–enhanced case management resulted in greater linkage to care within 30 days of release (odds ratio [OR] = 2.15; 95% confidence interval [CI] = 1.23, 3.75) and consistent retention over 12 months (OR = 1.95; 95% CI = 1.11, 3.46). Receipt of treatment for substance use disorders in jail also resulted in early linkage (OR = 4.06; 95% CI = 1.93, 8.53) and retention (OR = 2.52; 95% CI = 1.21, 5.23). Latinos were less likely to be linked to (OR = 0.35; 95% CI = 0.14, 0.91) or retained in (OR = 0.28; 95% CI = 0.09, 0.82) HIV care. Conclusions. Patient navigation supports maintaining engagement in care and can mitigate health disparities, and should become the standard of care for HIV-infected individuals leaving jail. Of the more than 2 million people incarcerated in the United States, 1,2 correctional facilities hold more than 20 000 people living with HIV. 3 The rate of HIV among incarcerated individuals is 5 times that of the general population, 3 largely because of increased incarceration for crimes related to drug use associated with HIV. 4,5 In San Francisco, California, nearly all individuals with HIV detained in jail reported active drug use in the 30 days before entering jail. 6 An estimated 1 in 7 people living with HIV leave prisons and jails each year in the United States, 7 and many struggle to access care and treatment upon release, with as many as 95% experiencing a gap in HIV treatment. 8–11 HIV care, including antiretroviral treatment, not only benefits the individuals who receive it but also prevents transmission of the infection. 12 However, challenges facing individuals when they leave jail as basic as finding housing and food can prevent or delay reintegration into HIV care in the community. 13,14 Reentry into the community can be a stressful and dangerous time for all individuals released from correctional settings and particularly hard for individuals with substance dependence. Enforced abstinence without drug treatment is the standard in most jails and prisons, and it does not adequately prepare an individual to cope when they are released. These individuals face higher risk of HIV transmission and death from overdose upon release compared with individuals without substance use disorders. 11 Discharge planning and intensive case management programs can help ease the transition back to the community. 15 Although strategies and practice vary from one setting to another, traditional case management coordinates social, mental health, medical, and other services for a client. Studies have shown variable success in HIV-related outcomes. 15–18 Some studies have shown associations between case management and improved HIV clinical outcomes, 19 and linkage to medical, social, and addiction services. 20 As an enhancement to case management or as a stand-alone, the patient navigation model, initially developed for cancer care, has been increasingly used with vulnerable HIV-infected populations. 21,22 The navigator, usually a nonclinical paraprofessional or peer, acts as a kind of a “coach” to the client. Navigators use a strengths-based philosophy to support clients in leveraging their own personal resources, talents, and strengths to best access available services. 22 Navigators do not take the place of traditional case managers, but work as part of a care team to ensure continuity of care. 21 To assess whether navigation could help HIV-infected individuals in jail successfully transition back into the community, we evaluated a navigation intervention delivered in San Francisco. This article describes the outcomes of the project in terms of linkage to and engagement in HIV care over the course of 1 year. We also examined intervention effects on substance use and risky sexual behavior.