Is HIV patient navigation associated with HIV care continuum outcomes?

Objective: To provide the first systematic review on the associations between HIV patient navigation and HIV care continuum outcomes (i.e. linkage to care, retention in care, antiretroviral therapy (ART) uptake, medication adherence, and viral suppression) in the United States. We identified primary research studies that addressed these associations and qualitatively assessed whether provision of patient navigation was positively associated with these outcomes, including strength of the evidence.

Methods: A systematic review, including both electronic [MEDLINE (OVID), EMBASE (OVID), PsycINFO (OVID), and CINAHL (EBSCOhost)] online databases and manual searches, was conducted to locate studies published from 1 January 1996 through 23 April 2018.

Results: Twenty studies met our inclusion criteria. Of these, 17 found positive associations. Patient navigation was more likely to be positively associated with linkage to care (five of six studies that assessed this association), retention in care (10 of 11), and viral suppression (11 of 15) than with ART uptake (one of four) or ART adherence (two of four). However, almost two-thirds of the 17 studies were of weak study quality, and only three used a randomized controlled trial design.

Conclusion: Available evidence suggests that patient navigation is a potentially effective strategy to enhance engagement in care among persons with HIV. However encouraging, the evidence is still weak. Studies with more rigorous methodological designs, and research examining characteristics of navigators or navigational programs associated with better outcomes, are warranted given the current interest and use of this strategy.