Leider, J., Fettig, J., & Calderon, Y. (2011). Engaging HIV-positive individuals in specialized care from an urban emergency department. AIDS patient care and STDs, 25(2), 89-93.
This week’s post is a summary of an article called “Engaging HIV-Positive Individuals in Specialized Care from an Urban Emergency Department”. The study involves an intervention to promote linkage to HIV care using testing staff as patient navigators in an emergency department in the Bronx. We thought a brief explanation of the intervention and the resulting linkage to care rate would prove interesting.
At an emergency department in the Bronx, public health advocates (PHAs) who were trained in HIV testing and counseling approached patients and offered an HIV test. Patients who chose to participate watched a pre-test video and had the opportunity to ask the PHA any questions. While the test was running, patients also watched a post-test educational HIV prevention video. Then the PHA returned to provide tailored HIV counseling and deliver the results to the patient.
The process for those who tested positive for HIV is outlined in FIG 1. below. Those with a positive preliminary test result were given a confirmatory test and if the test was done between 9:00 AM and 5:00 PM, the patient was escorted by the PHA to an HIV care clinic within the same network as the emergency department. At the HIV clinic, the patient was met by a nurse, social worker or case manager who provided counseling and assisted with enrolling the patient into health insurance if needed. If there was an available physician, the patient also had an initial HIV clinical visit, otherwise, a medical appointment was scheduled for the patient. If the preliminary test was done outside of open clinic hours, the PHA exchanged contact information and scheduled to meet the patient at the emergency department during the next business day. PHAs were also responsible for following up with patients who missed their initial appointment.
Out of 116 patients who tested positive, 93 were newly diagnosed and 83.6% were linked to care within 30 days. Linkage to care was defined as the patient having a comprehensive examination by an HIV physician. Leider et al. explained their approach to actively linking patients into care in the following quotation:
“By changing a passive referral process to an active seamless engagement in care using the PHA as facilitator, we have changed the role of the ED HIV tester. The PHA can provide focused counseling to high risk patients when needed and becomes a client navigator to immediately engage a person who tests positive into care.”
Patient navigators can assist patients in handling the complex healthcare system and accessing the resources, services and quality medical care available for managing living with HIV. Patient navigation can be provided by peers, staff or even clinical providers. In this case, patients were assisted by the same person who conducted the HIV test, delivered the results and provided counseling, thereby facilitating quick and active linkage into HIV medical care.
Written by Lea Hane