Effect of Patient Navigation With or Without Financial Incentives on Viral Suppression Among Hospitalized Patients With HIV Infection and Substance Use: A Randomized Clinical Trial

摘要: Importance Substance use is a major driver of the HIV epidemic and associated with poor care outcomes. Patient navigation (care coordination case management) financial incentives for achieving predetermined outcomes are interventions increasingly promoted to engage patients in substance disorders treatment care, but there little evidence their efficacy improving HIV-1 viral suppression rates. Objective To assess effect structured patient intervention or without improve rates among elevated loads recruited as hospital inpatients. Design, Setting, Participants From July 2012 through January 2014, 801 infection from 11 hospitals across United States were randomly assigned receive alone (n = 266), plus (n = 271), usual (n = 264). plasma load was measured at baseline 6 12 months. Interventions included up sessions management motivational interviewing techniques over Financial (up $1160) provided targeted behaviors aimed reducing use, increasing engagement Treatment standard practice each linking hospitalized outpatient treatment. Main Outcomes Measures The primary outcome (≤200 copies/mL) relative nonsuppression death 12-month follow-up. Results Of randomized, 261 (32.6%) women (mean [SD] age, 44.6 years [10.0 years]). There no differences versus 3 groups Eighty-five 249 (34.1%) usual-treatment group experienced success compared 89 (35.7%) navigation-only difference 1.6% (95% CI, −6.8% 10.0%;P = .80) 98 254 (38.6%) navigation-plus-incentives 4.5% CI −4.0% 12.8%;P = .68). between −2.8% −11.3% 5.6%;P = .68). Conclusions Relevance Among did not have beneficial on months vs usual. These findings do support these this setting. Trial Registration clinicaltrials.gov Identifier:NCT01612169