Introducing HIV health system navigators: Lessons learned from an urban public health care system

Background:  Philadelphia estimates show that while linkage to HIV care is comparable to the national rate, retention in care is a point of steep drop-off with 54% of HIV-diagnosed residents retained (45% nationally).   New interventions to improve engagement in care are urgently needed.  We present a retention-in-care program of system navigation in the 8 City of Philadelphia safety net health centers, which provide high-quality care to 100,000 Philadelphians annually in under-served neighborhoods, of whom over 1,000 are treated for HIV.

Methods:  Beginning in 2012, Philadelphia implemented a privately-funded health system navigation (HSN) demonstration project.  Project staff identify persons newly diagnosed with HIV or out of HIV care in the City’s federally qualified look-alike facilities, and provide intensive HSN services. The goals are to increase the number of patients engaging in ongoing HIV care.

Results:  Between March and September 2013, 304 HIV-infected persons were referred for HSN services; 134 were enrolled. Of those newly diagnosed, 100% were enrolled within 30 days of referral and 75% received care within 30 days.  For other patients, 61% were enrolled within 30 days, and 84%% received care within 90 days.  Among enrolled patients, CD4 cell counts increased (419 to 472 cells/ml) and viral load decreased (34,271 to 13,531 copies/ml) during navigation. Retrospectively, investigators linked data for the referred but not enrolled to surveillance data to determine patient disposition.

Conclusions:  Using HSN to assist patients to navigate HIV care systems facilitates access to care in an urban public health FQHC look-alike setting, and improves virologic and immunologic outcomes.