Date of Award

Spring 2021

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

Alyssa Robillard

Abstract

Peer navigation programs have been identified as a potential motivator in care engagement and retention for patients living with HIV, although the data is inconsistent. HIV management requires important disease management considerations and innovative approaches for patient care. Medication advancements and technology have drastically improved care for most patients living with this chronic disease; yet African Americans contract, live with, and die because of HIV-related complications at disproportionately higher rates compared to their White peers.The purpose of this exploratory mixed-methods outcome evaluation is to: (1) determine if peer navigation is a viable intervention to improve three key HIV care metrics: viral suppression, care engagement and care retention; and (2) better understand factors associate with PNP that encourage and discourage participation for African American patients living with HIV at the Palmetto State HIV Center in South Carolina from January 1, 2016 to December 31, 2018. Of the Palmetto State HIV Center’s 972 HIV patients, 64.8% (n=630) were African American; and 24.4% (n=154) were enrolled in the PNP. A

stepwise process resulted in 96 African American patients being included in this exploratory matched case-control quantitative evaluation. Forty-eight (48) PNP patients were randomly matched with 48 Non-PNP patients controlling for gender, age, initial CD4 count, and self-reported HIV risk factor. Additionally, fifteen African American adults living with HIV and receiving care at a clinic in South Carolina were interviewed to better understand the patients’ perception of a Peer Navigation Program (PNP) and to identify key factors that encourage or discourage participation.Results suggested one positive outcome and a few complimentary program strengths. There was a significant change in the proportion of PNP patients that were virally suppressed after engagement in the PNP. When considered alongside responses from the patient interviews, there were several components from the PNP that promoted medication adherence to include authentic connections with their providers, extended appointment times, and high-quality comprehensive care. There was no significant difference in engagement or retention within the PNP group or between the PNP and Non-PNP groups.

Peer navigation is an intervention in HIV care and has the potential to be a promising service for the patients of the Palmetto State HIV Center. A process evaluation is recommended to fully understand the nuances of the full service delivery, from patient recruitment to facilitation to patient discharge. A multidisciplinary team of administrators and evaluators should work collaboratively with the Peer Navigation and behavioral health team to fully understand patient needs and how they coincide with the purpose of the PNP.

Rights

© 2021, Kimberly Butler Willis

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