Developing a Patient Navigation Program to Improve Engagement in HIV Medical Care and Viral Suppression: A Demonstration Project Protocol.

Individuals diagnosed and living with HIV who are out of care or who have persistent viremia are at risk for poor health outcomes and are estimated to account for two-thirds of all new HIV infections. As part of a six-state demonstration project to improve access to care for hard-to-reach populations, Wisconsin developed an HIV-specific patient navigation program to improve engagement in HIV care and viral suppression for populations at risk for poor HIV care outcomes. Patient navigators worked with individuals who were out of HIV medical care or were at risk of falling out of care over nine months to identify and address barriers to care. This manuscript describes the patient navigation program and rationale, and lessons learned that should be considered by sites developing similar programs.

"She makes me feel that I'm not alone": linkage to Care Specialists provide social support to people living with HIV.

Wisconsin's Linkage to Care intervention incorporates elements of individually tailored patient navigation and case management designed to increase linkage and retention in HIV-related medical care. It is delivered by Linkage to Care Specialists in HIV medical clinics and community-based agencies. Researchers interviewed a diverse sample of clients to conduct preliminary evaluation of the pilot phase of this intervention. The participants' relationships with their Specialists emerged as a major unifying theme of the data. Comfortable and close relationships with Specialists served as motivation to adhere to medical care, mitigated negative feelings associated with HIV-related stigma, and resulted in increased comfort with medical care and positive health outcomes including engagement in care and undetectable viral load. As a result of the Specialists' support, many participants were reluctant to transition out of the Linkage to Care program. The positive effects demonstrated by Specialists are balanced against the costs of small caseloads that are potentially not feasible within traditional case management models. Future interventions to increase medical care engagement, among HIV+ individuals at risk of lack of engagement, should develop strategies to "personalize" the patient experiences within health care and psychosocial services delivery systems, as well as screening tools to triage clients into different levels of personal service provision intensity based on need and desire.