2015 APHA Annual Meeting & Expo

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Online Program

323017
Nursing navigation as a linkage to care intervention


Tuesday, November 3, 2015 : 9:20 a.m. - 9:45 a.m.

Evelyn Byrd Quinlivan, M.D., Institute for Global Health and Infectious Diseases; UNC Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
Lynne C. Messer, Ph.D., Community Health - Urban & Public Affairs (SCH), Portland State University, Portland, OR
Andrea Blickman, RN, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel HIll, Chapel Hill, NC
Katya Roytburd, MPH, Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
Kristen Sullivan, PhD, MSW, MA
Adaora A. Adimora, MD, MPH, Division of Infectious Diseases, University of North Carolina-Chapel Hill, Chapel Hill, NC
Heather Parnell, MSW, Center for Health Policy and Inequalities Research, Duke University, Durham, NC
Miriam Berger, MPH, Center for Health Policy and Inequalities Research, Duke University, Durham, NC
Tyffany Coleman, BS, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel HIll, NC
Lynda Bell, NP, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
Jonah Pierce, RN, Infectious Diseases Clinic, UNC Health Care, Chapel Hill, NC
Mugdha Golwalkar, MPH, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel HIll, NC
Audio (mp3) recording Recorded Presentation (mp4)
Background: US women of color (WOC) bear a high burden of HIV, with many barriers to care. Systems navigation support promises to improve engagement in care, though limited literature supports its use at present. Self-determination theory (SDT) postulates that behavior change is sustained when three core needs are met (relatedness, competency, autonomy) and intrinsic motivation is supported. 

Objective: The Guide to Healing Program sought to retain HIV-positive WOC in HIV care using self-determination support provided by a nurse (RN) with mental health experience, called a ‘nurse guide’ (NG).  

Methods: NG activities promoted competency (HIV education), autonomy (self-care materials, system navigation coaching) and relatedness (check-ins, reminders, transportation support).   Linear regression was used to assess the relationships between numbers of contacts, time spent, number of autonomy, competency, relatedness interventions, and HIV-related variables with Beta-coefficients (β), odds ratios and 95%CI.

Results: The 133 participants were 95% AA, 44 yrs (ave.), 35% uninsured, 31% new to care, 34% transferring care, 24% without regular care, 11% engaged in care (with co-morbidity or adherence difficulty).  Consistent with participation by new and out-of-care patients, lower CD4 counts were associated with NG patient contacts (β: -8.332; -13.551, -3.113), and competency contacts (β: -19.972; -30.54, -9.404).  Change from a detectable to a non-detectable viral load (usual threshold @ 50c/ml) was also associated with all patient contacts (aOR:1.052; 1.002, 1.105) and competency contacts (aOR:1.107; 1.003, 1.222).   

Conclusions: Patient navigation provided by a NG offers an innovative and promising approach to engagement in HIV care for WOC throughout the care continuum.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
List at least two examples of activities that support women’s self-determination needs. List two interventions that were associated with HIV viral suppression.

Keyword(s): HIV/AIDS, Nurses/Nursing

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator of Guide to Healing, a HRSA SPNS-funded initiative since 2009. In that role, I have overseen all research activities. I have been PI on many other funded initiatives including Ryan White Part B and Part C to the UNC Infectious Diseases Clinic, as well as an oral health initiative.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4076.0: Violence & viruses: Linkages and barriers to care for HIV positive women