HIV Nurse Navigator
USA
2017
A recent study evaluated the effectiveness of a nurse navigator program in supporting engagement in care and improving clinical outcomes among veterans with HIV. For those who used the nurse navigator program, the number of clinic visits doubled, medication renewal increased from 41% to 81%, and attainment of an undetectable viral load (<200 copies/mL) increased from 48% to 69% after approximately one year.
Nurse-led navigation program
The program employed a nurse who provided HIV education, appointment reminders to support clinic attendance, and adherence support interventions to veterans. Patients were referred for navigation if they were identified as being poorly engaged (e.g., multiple no shows for appointments, inconsistent medication renewals, and elevated viral loads) by a member of the clinical team. An intensive follow-up process for missed appointments was used, which included the nurse navigator calling both the veteran and emergency contacts.
A variety of strategies to increase adherence to medication and clinic engagement were used, including:
- reminder calls (appointments and medication renewal)
- text reminders
- same-day walk-in appointments
- collaboration with family members and medical staff
- pillbox renewals
This study took place within the Veterans Affairs (VA) Infectious Disease (ID) primary care clinic in Washington DC, which strives to create an inclusive and accepting “medical home” for veterans.
Results
Patients referred to the nurse-led navigation program were compared with the overall cohort of veterans with HIV who were receiving care from the ID primary care clinic. At the start of the program, those who enrolled in the nurse navigator program were less likely to have a viral load <200 copies/mL, less likely to live in permanent housing, more likely to have substance use, and more likely to have comorbid depression or a disability than the overall ID primary care clinic study cohort.
When participants in the nurse navigation program were followed up approximately one year after they enrolled in the program, the percentage of participants with a viral load of <200 cells/mL increased from 48% to 69%. Additionally, the study found a significant increase in the average number of clinic visits (from one to two clinic visits) and in the rate of medication renewal (from 41% to 81%).
What does this mean for Canadian service providers?
This study demonstrates the importance of individualized care in a vulnerable population with a variety of comorbid conditions, as well as the potential benefits to having a nurse navigator as part of a primary care team treating people with HIV.
This program worked with a group of poorly engaged veterans; however, there is potential that this approach could also be used in other populations that show signs of poor engagement.
Examples of patient navigation services exist in the Canadian context, for example, Peer Navigation Services and Chronic Health Navigation Program. This study provides an additional example of the roles that a patient navigator could play, as well as the potential benefits to having a nurse provide a navigation role as a member of the treatment team.
Related resources
Health Navigation – Evidence Review
Patient Navigation – Evidence Brief
ARTAS – Evidence Brief
Effective Interventions: Patient Navigation Resources and Tools – Center for Disease Control and Prevention
References
Hemmy Asamsama O, Squires L, Tessema A, et al. HIV Nurse Navigation: Charting the course to improve engagement in care and HIV virologic suppression. Journal of the International Association of Providers of AIDS Care. 2017; 1-5.