Improved health care system navigation may improve treatment adherence in urban populations

Coordinated efforts to keep patients in the health care system may improve antiretroviral therapy adherence among urban populations with HIV, according to findings presented at the 2009 meeting of the International Association of Physicians in AIDS Care, held recently in New Orleans.

Fabienne Laraque, MD, MPH, of the New York City Department of Health and Mental Hygiene presented a description of a program conducted in New York using Ryan White funding. She said that the program used:

outreach for return to care
health system navigation
a structured curriculum
facilitated linkage to social support services
partnership and information exchange between care coordination and HIV primary care providers

Laraque said that surveillance and provider data were used to plan the programs in areas of New York City that were not only hardest hit by HIV/AIDS, but that had the highest mortality rates due to poor adherence and retention in care.

“The goal was to do everything possible to ensure that patients get to appointments,” Laraque said. “This involved having a coach or helper to get them to treatment, to return to care.”

Laraque said that health education was a key component. Patients were instructed on a variety of subjects from the biology of adherence to ways of navigating insurance systems.

“Close collaboration between partners was also important,” she said. “A constant exchange of information between navigators, providers and patients was a critical element to the program. We wanted everyone involved informed of when therapies and strategies changed, when and how structural barriers impacted treatment, and so forth.”

The main goal was autonomy, according to Laraque. “We really wanted to show that patients can become self-sufficient,” she said. “This is not a short-term program. We want to take the time to get patients on their feet.”

Abstract #: 0156.