Peer Engagement for Navigating HIV Care

Segment Description: Mo Wahome, MPH, co-principal investigator and data manager at the AIDS Care Group, and Allison Byrd, a peer navigator with the AIDS Care Group, discuss the racial disparities that exist in the HIV/AIDS care continuum for women of color, as well as how a peer engagement and retention program can help.

Interview Transcript (modified slightly for readability):

Wahome: Some of the racial disparities that have existed for women of color especially have been housing or lack of stable housing. Some of the women that we have worked with come from low-income communities and so then seeking HIV care, staying in care, becomes not high on the priority list when they have to worry about where they're going to live. Some of them

living in a low-income community, then it means sometimes they live in a food desert, so then access to good food is also a big issue. So that affects their day to day lives and if they take the medication or not, and so that's how they end up falling off the care continuum.

Another thing is transportation. We've had women who have to take 2 or 3 buses to get to clinic. Or if they have competing priorities like low-income jobs, and they have to work more than 1 job, so then making time to go to a medical appointment becomes a challenge.

Some of these challenges have become more apparent to us. And so while we're trying to address these disparities, we have to collect all the information on housing and transportation, whether they have social support or social networks, because that also impacts how they fare in their treatment and accessing care.

We've had a group of women who also come from Africa, and they have different set of challenges with disparities. Having language barriers, not knowing how to navigate the US medical system, changing medication from what they were getting back home to what is now in America, that also plays a role in disparities. And so when we're talking about HIV disparities, it's important to have a deeper understanding of upstream causes, why do disparities exist, and how to better systematically address them instead of just looking at the clinical aspect.

Byrd: That implementation was women of color who have been out of care for over six months, newly diagnosed. Clients who were newly diagnosed, we tried to get them into care, you had to see a case manager, you had to least get 2 doctor visits, try to help as far as getting housing and stuff later on.

We tried to make sure that the clients no matter what got their medical appointments, see the doctor, if they had any mental or any kind of drug abuse, we sent them to some of our offices to meet with our physical therapy people and different things that they really need help with.

For example, for newly diagnosed clients, being scared, especially going to a new doctor. And finding out the doctor is just a doctor, somebody that's not like them dealing with HIV. To have that person that is, that's been living with HIV, to be able to help them and talk with them and show them that it's not the end of the world, “here, I've had HIV for 19 years and look at me,” I can't say the same thing will happen with you but to let you know that there is somebody that loves them and cares for them.

Wahome: In addition to the peer navigation part we also administered baseline interviews and follow-up interviews. And so part of the interview was also collecting the data on

the social support networks, barriers to care. When we followed up with them in 3 months and 6 months, then we're able to see if some of these barriers had been addressed or it was still an issue, and so that information also helps guide our clinicians on how to best treat the whole person.

Ann Ferguson, MSN, RN, chief operating officer of AIDS Care Group, and Gwen Verlinghieri, MSN, CRNP, AAHIVS, ACRN, nurse practitioner at AIDS Care Group, share the key findings from a peer engagement and retention intervention to enhance the HIV care continuum among women of color.

Interview Transcript (modified slightly for readability):

Ferguson: So this was a HRSA (Health Resources and Services Administration) sponsored program that was part of a special projects of national significance initiative. And they were replicating a grant that had been done several years ago. And what we found, we enrolled 80 women of color that had, as Allison said, had been out of care for six months or more, or were newly diagnosed and all had virus when they first came in.

I think we achieved 77% viral suppression within the first three months. We linked a lot of people to care and services, particularly housing and transportation, and got insurance for people when we could, that kind of stuff.

We definitely learned that having a peer on staff who's able to integrate into all aspects of the clinic was really, really helpful. So we're going to keep that program around.

So what we're going to do is integrate Allison into our already established outreach program. We are a fully funded Ryan White AIDS service organization, we get Ryan White parts A, B, C, and D.

And so Gwen, as our lead clinician, with the women, can speak to how keeping Allison on staff as part of our outreach team, helping women navigate their services will be a huge help, particularly for women's health care.

Verlinghieri: If it wasn't for Allison to come with the patients to the visits, they probably wouldn't come. It's real hard to get women to stay in care. And these women are already fragile, with the stigma attached.

Our clinic is fabulous to have Allison on staff come in. So it's a team effort. We're all in the exam room together. They feel comfortable already because they they've met her. She introduces them to me and the rest of the team. And every visit that she comes with them, if they have to go to a specialist we refer, she'll go with them, she'll help them get their appointments, transportation. It's just a continuum of a of a team effort.

Ferguson: She documents the services that she provides in our electronic medical record. She's a part of our case conferences, case management and outreach meeting, so it's really been integrated and we will definitely continue with Allison and down the road probably will hire another peer navigator as well.