A new study appearing in the July 2016 issue of the Journal of the American Medical Association suggests that due to the complexity of certain patients’ cases — i.e., those with substance use disorders and HIV — patient navigation isn’t particularly effective in improving outcomes.
However, the study’s authors were careful to point out that a patient’s individual circumstances may have disproportionately impacted the study’s outcomes, starting with the substances used:
It is possible that the lack of substance use disorders treatment options affected study results. Participation in substance use disorders treatment was low across groups with no decrease in overall substance use and severity of use. In the study interventions, patient navigators sought to engage participants using substances with available treatment services. Several study sites did not reside in jurisdictions that offered harm reduction services. Also, the majority of the study participants used stimulants, a group that was less likely to become virally suppressed compared with those who only used opiates, alcohol, or both. Although the availability of substance use disorders treatment in locations of study sites was not measured, this suggests the need for more acceptable or accessible interventions for substance use disorders treatment, particularly among stimulant users.
The authors also found that a patient’s ethnicity and geographic location played a role in outcomes, suggesting that greater challenges need to be addressed before the patient navigation model can be truly effective for certain patients:
The study results raise the question of whether intensive, individual-level interventions are sufficiently broad and robust enough to improve HIV outcomes among populations currently not benefit ting from treatment. Most participants were low-income persons of color who may experience negative sociocultural factors such as poverty, racism, unstable housing, HIV-related stigma, and high rates of incarceration. Systemic and structural barriers to care may be difficult to overcome with an individual-level behavioral intervention, even an intensive one; for example, this study found that black participants (compared with white participants) and participants from southern sites were less likely to be virally suppressed.