A Nurse Care Management Program for HIV Prevention Among Youth Experiencing Homelessness

HIV prevalence is as high as 12% in young people experiencing homelessness. This population is also 6 to 12 times more likely to become infected with HIV than housed youth. Obstacles to HIV prevention and care among youth experiencing homelessness are compounded by substance use, housing instability, and mental illness. These obstacles present a need to develop targeted interventions for this population.

Few HIV prevention programs prioritize the prevention needs of youth experiencing homelessness, but an oral abstract session at the Association of Nurses in AIDS Care Conference (ANAC 2019) discussed the development of a protocol for nurse care management for HIV prevention called NCM4HIV.

NCM4HIV integrates a theoretical framework, methodology for behavioral change, and practical strategies designed to engage youth experiencing homelessness, with an outcome evaluation plan. The program builds on past nurse care management using the Comprehensive Health Seeking and Coping Framework. NCM4HIV also incorporates the psychological modality known as motivational interviewing. Results of behavioral interventions will then be accounted for through behavioral feedback technology, allowing case management specialists to further tailor the intervention through goal setting and patient response.

Abstract authors plan to enroll and follow youth experiencing homelessness for 9 months. The outcome evaluation plan will then determine whether the enhanced nurse care management intervention improves uptake of HIV prevention strategies among youth experiencing homelessness compared to standard care using an attention controlled randomized trial design.

Explaining the implications for practice of the new protocol, abstract authors wrote that “a nurse-led intervention eliminates the need to refer youth experiencing homelessness to other medical professionals for HIV prevention services, a step that may increase compliance. This is particularly important as being homeless can decrease effectiveness of linkages to care vs. providing care at the point of-contact.”

The abstract authors noted that nurses are already integrated into most current HIV programs for youth experiencing homelessness, making their intervention sustainable and able to be incorporated into existing HIV prevention programs.

NCM4HIV thus has the potential to be integrated into existing social services in order to enhance HIV prevention among youth experiencing homelessness to improve access to mental health and housing services.

The abstract, Come As You Are - Designing a Nurse Case Management HIV Prevention and Care Intervention among Youth Experiencing Homelessness, was presented in an oral abstract session at ANAC 2019 in Portland, Oregon.