Effectiveness of a Peer Navigation Intervention to Sustain Viral Suppression Among HIV-Positive Men and Transgender Women Released From Jail,JAMA Internal Medicine

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Effectiveness of a Peer Navigation Intervention to Sustain Viral Suppression Among HIV-Positive Men and Transgender Women Released From Jail
JAMA Internal Medicine ( IF 22.5 ) Pub Date : 2018-04-01 , DOI: 10.1001/jamainternmed.2018.0150
William E. Cunningham _{1,

2} , Robert E. Weiss ₃ , Terry Nakazono ₁ , Mark A. Malek _{4,

5} , Steve J. Shoptaw ₆ , Susan L. Ettner _{1,

2} , Nina T. Harawa _{1,

5,

7}

Affiliation

Importance Diagnosis of human immunodeficiency virus (HIV) infection, linkage and retention in care, and adherence to antiretroviral therapy are steps in the care continuum enabling consistent viral suppression for people living with HIV, extending longevity and preventing further transmission. While incarcerated, people living with HIV receive antiretroviral therapy and achieve viral suppression more consistently than after they are released. No interventions have shown sustained viral suppression after jail release. Objective To test the effect on viral suppression in released inmates of the manualized LINK LA (Linking Inmates to Care in Los Angeles) peer navigation intervention compared with standard transitional case management controls. Design, Setting, and Participants Randomized clinical trial conducted from December 2012 through October 2016 with people living with HIV being released from Los Angeles (LA) County Jail. All participants were (1) 18 years or older; (2) either men or transgender women diagnosed with HIV; (3) English speaking; (4) selected for the transitional case management program prior to enrollment; (5) residing in LA County; and (6) eligible for antiretroviral therapy. Main Outcomes and Measures Change in HIV viral suppression (<75 copies/mL) over a 12-month period. Interventions During the 12-session, 24-week LINK LA Peer Navigation intervention, trained peer navigators counseled participants on goal setting and problem solving around barriers to HIV care and adherence, starting while the participants were still in jail. After their release, they continued counseling while they accompanied participants to 2 HIV care visits, then facilitated communication with clinicians during visits. Results Of 356 participants randomized, 151 (42%) were black; 110 (31%) were Latino; 303 (85%) were men; 53 (15%) were transgender women; and the mean (SD) age was 39.5 (10.4) years. At 12 months, viral suppression was achieved by 62 (49.6%) of 125 participants in the peer navigation (intervention) arm compared with 45 (36.0%) of 125 in the transitional case management (control) arm, for an unadjusted treatment difference of 13.6% (95% CI, 1.34%-25.9%; P = .03). In the repeated measures, random effects, logistic model the adjusted probability of viral suppression declined from 52% at baseline to 30% among controls, while those in the peer navigation arm maintained viral suppression at 49% from baseline to 12 months, for a difference-in-difference of 22% (95% CI, 0.03-0.41; P = .02). Conclusions and Relevance The LINK LA peer navigation intervention was successful at preventing declines in viral suppression, typically seen after release from incarceration, compared with standard transitional case management. Future research should examine ways to strengthen the intervention to increase viral suppression above baseline levels. Trial Registration clinicaltrials.gov Identifier: NCT01406626

中文翻译：

同伴导航干预对从监狱释放的 HIV 阳性男性和跨性别女性维持病毒抑制的有效性

人类免疫缺陷病毒 (HIV) 感染的诊断、护理的联系和保留以及坚持抗逆转录病毒治疗是护理连续过程中的步骤，能够持续抑制 HIV 感染者的病毒，延长寿命并防止进一步传播。在被监禁期间，艾滋病毒感染者接受抗逆转录病毒治疗，并且比被释放后更稳定地抑制病毒。出狱后没有任何干预措施显示出持续的病毒抑制。目的与标准的过渡案例管理控制相比，测试手动 LINK LA（将囚犯与洛杉矶的护理联系起来）同伴导航干预对释放的囚犯的病毒抑制效果。设计，设置，和参与者 2012 年 12 月至 2016 年 10 月期间进行的随机临床试验，试验对象是从洛杉矶 (LA) 县监狱释放的 HIV 感染者。所有参与者均为 (1) 18 岁或以上；(2) 被诊断出患有 HIV 的男性或跨性别女性；(3) 会说英语；(4) 在入学前被选为过渡案例管理项目；(5) 居住在洛杉矶县；(6) 符合抗逆转录病毒治疗的条件。主要结果和措施 12 个月内 HIV 病毒抑制（<75 拷贝/毫升）的变化。干预在为期 12 次、为期 24 周的 LINK LA 同伴导航干预期间，受过培训的同伴导航员在参与者仍在监狱中时就围绕 HIV 护理和依从障碍的目标设定和问题解决向参与者提供咨询。他们获释后，他们在陪同参与者进行 2 次 HIV 护理访问时继续提供咨询，然后在访问期间促进与临床医生的沟通。结果在随机分配的 356 名参与者中，151 名 (42%) 是黑人；110 (31%) 名拉丁裔；303 (85%) 名男性；53 (15%) 名跨性别女性；平均 (SD) 年龄为 39.5 (10.4) 岁。在 12 个月时，对等导航（干预）组的 125 名参与者中有 62 名（49.6%）实现了病毒抑制，而过渡病例管理（对照组）中的 125 名参与者中有 45 名（36.0%）实现了病毒抑制，未经调整的治疗差异为13.6%（95% CI，1.34%-25.9%；P = .03）。在重复测量、随机效应、逻辑模型中，病毒抑制的调整概率从基线的 52% 下降到对照组的 30%，而同行导航组的患者从基线到 12 个月的病毒抑制率保持在 49%，差异为 22%（95% CI，0.03-0.41；P = .02）。结论和相关性与标准的过渡病例管理相比，LINK LA 同伴导航干预成功地防止了病毒抑制的下降，这通常是在从监禁释放后看到的。未来的研究应该研究加强干预以将病毒抑制提高到基线水平以上的方法。试验注册clinicaltrials.gov 标识符：NCT01406626 与标准的过渡案例管理相比。未来的研究应该研究加强干预以将病毒抑制提高到基线水平以上的方法。试验注册clinicaltrials.gov 标识符：NCT01406626 与标准的过渡案例管理相比。未来的研究应该研究加强干预以将病毒抑制提高到基线水平以上的方法。试验注册clinicaltrials.gov 标识符：NCT01406626

更新日期：2018-04-01

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