Outcomes from the Adaptation of an Evidence-Based Peer Linkage & Re-Engagement Intervention for Women of Color with HIV in Three Urban Clinics.

Peer interventions have demonstrated efficacy with improving HIV health outcomes. Yet, little is known about factors associated with their uptake into the clinic setting. Three urban sites in the US were funded to adapt, implement and evaluate a peer intervention to improve HIV health outcomes for 173 out of care and newly diagnosed women of color. Peers worked with cis and transgender women of color for four months to achieve the goals of linkage and retention in HIV case management and medical care. Results were 96% of women were linked to medical care, 73% were retained in care and 81% were virally suppressed post 12 months. The average duration of the peer intervention was seven months. Women who received four peer encounters had a 10% increase in retention in care and viral suppression. The findings highlight key elements such as dose and duration of client interaction for peer staff as part of the health care team.

Unmet Needs Among Out of Care and Recently Diagnosed Women of Color With HIV: Opportunities for Focused Interventions.

OBJECTIVE: Women of color (WoC) have lower retention in care and higher HIV/AIDS-related morbidity, compared with other populations. Barriers to care include lack of family support, inadequate HIV/AIDS services, and stigma, and women may face greater unmet needs for services including housing and employment. This descriptive study explores the unmet needs of WoC participating in the Health Resources and Services Administration's Special Projects of National Significance (SPNS) Program, Dissemination of Evidence Informed Interventions (HRSA/SPNS DEII) Initiative. SETTING: Six urban health clinics across the United States. PARTICIPANTS: Eligible participants were cis- or transgender women who were newly diagnosed with HIV/AIDS in the past 12 months, out of care for at least 6 months, or not virally suppressed. Participants enrolled from November 2016 to November 2018. MAIN OUTCOMES: Our primary outcome of interest was unmet needs at enrollment for 6 core services: housing, transportation, benefits, mental health or substance use treatment, medication assistance, and medical care. We examined differences in unmet needs stratified by participant characteristics and used multivariate regression to identify the social and health risk factors associated with higher unmet needs. RESULTS: Among the 529 WoC, the most frequently reported expressed needs were transportation (50.1%), housing (41.2%), benefits (28.2%), medication assistance (24.5%), and substance use or mental health treatment (24.3%). Participants with a significantly higher number of overall unmet needs included those who were older (40 years or older), were unstably housed, had a history of incarceration, identified as a transgender woman, were US born, had no caregiver responsibilities, and did not have a case manager at enrollment. CONCLUSIONS: Our findings indicate the importance of screening for and developing focused strategies to address the unmet needs for WoC if viral suppression is to be achieved.

The Influence of Housing Status on the HIV Continuum of Care: Results From a Multisite Study of Patient Navigation Models to Build a Medical Home for People Living With HIV Experiencing Homelessness.

Objectives. To examine the effect of patient navigation models on changes in housing status and its subsequent effects on HIV outcomes for 700 people living with HIV (PLWH) who were unstably housed with co-occurring substance use and psychiatric disorders across 9 demonstration sites in the United States between the years of 2013 and 2017.Methods. Self-reported housing status was collected at baseline, and at 6 and 12 months during the intervention. HIV outcomes included linkage and retention in care, antiretroviral therapy prescription, and viral suppression collected via chart review.Results. In the 12 months after the intervention, 59.6% transitioned to more stable housing. Compared with those who became or remained unstably housed, participants with greater stability achieved significantly higher rates of retention (adjusted odds ratio [AOR] = 2.12; 95% confidence interval [CI] = 1.11, 4.05), were more likely to be prescribed antiretroviral therapy (AOR = 2.06; 95% CI = 1.62, 2.63), and had higher rates of viral suppression (AOR = 1.62; 95% CI = 1.03, 2.55).Conclusions. The use of patient navigators to create a network of services for PLWH who are unstably housed can improve housing stability and lead to improvements in HIV-related outcomes.