Reciprocal Innovation – Bridging the Gap from the Hospital to the Clinic: Using Peer Navigators on the Inpatient Wards to Improve Linkage, Retention and Adherence to HIV Care in Western Kenya2020-08-11T12:40:16-04:00

Bridging the Gap from the Hospital to the Clinic: Using Peer Navigators on the Inpatient Wards to Improve Linkage, Retention and Adherence to HIV Care in Western Kenya

Principal Investigator Rakhi Karwa
International Collaborator(s)
Project Title Bridging the Gap from the Hospital to the Clinic: Using Peer Navigators on the Inpatient Wards to Improve Linkage, Retention and Adherence to HIV Care in Western Kenya
Priority Area The study will evaluate the impact of the inpatient HIV peer navigator program on the linkage, retention and adherence of HIV-infected patients admitted to the inpatient adult medicine wards at Moi Teaching and Referral Hospital. Linkage and retention of patients is paramount to the provision of HIV care and rates in HIV programs in Sub Saharan Africa are as low as 40% and 60%, respectively. Because lost to follow up can predict death among HIV patients, current research must focus on understanding methods of improving the rates of which patients remain in care. By leveraging their unique personal experiences with addressing their own disease, peer navigators are able to offer support to other HIV patients and help them overcome the many barriers they face in accessing care. They are specifically trained to assist patients by helping patients understand the unique challenges of living with HIV, navigating the healthcare system as well as providing opportunities to improve HIV self-care and adherence to Highly Active Antiretroviral Therapy (HAART). Research experiences with utilizing HIV peer navigators within the care cascade at AMPATH has included using peer navigators to facilitate linkage and early retention in care for patients diagnosed with HIV at our outpatient testing sites and clinics, providing patient counseling, HIV status disclosure support, adverse events monitoring, and outreach activities targeting defaulters to care.
The Intervention The study will evaluate the impact of the inpatient HIV peer navigator program on the linkage, retention and adherence of HIV-infected patients admitted to the inpatient adult medicine wards at Moi Teaching and Referral Hospital. Linkage and retention of patients is paramount to the provision of HIV care and rates in HIV programs in Sub Saharan Africa are as low as 40% and 60%, respectively. Because lost to follow up can predict death among HIV patients, current research must focus on understanding methods of improving the rates of which patients remain in care. By leveraging their unique personal experiences with addressing their own disease, peer navigators are able to offer support to other HIV patients and help them overcome the many barriers they face in accessing care. They are specifically trained to assist patients by helping patients understand the unique challenges of living with HIV, navigating the healthcare system as well as providing opportunities to improve HIV self-care and adherence to Highly Active Antiretroviral Therapy (HAART). Research experiences with utilizing HIV peer navigators within the care cascade at AMPATH has included using peer navigators to facilitate linkage and early retention in care for patients diagnosed with HIV at our outpatient testing sites and clinics, providing patient counseling, HIV status disclosure support, adverse events monitoring, and outreach activities targeting defaulters to care.
Key Facilitators The study represents a collaboration of faculty and staff from Purdue University, Indiana University, Moi University, the Academic Model Providing Access to Healthcare (AMPATH), and MTRH in Eldoret, Kenya.
Target Population In 2014, approximately 50 HIV patients, including newly diagnosed and known positive patients, were admitted to the Nyayo wards each month. In October 2015, MTRH increased their number of HIV testing counselors throughout the hospital. The data recently generated for October 2015 shows that approximately 80 patients admitted to the Nyayo wards were HIV-infected, with roughly 20 newly diagnosed and 60 known positive patients. The study period took place from April 2016 – January 2017. During this time, it is estimated that the inpatient HIV peer navigators interacted with approximately 800 patients in the hospital setting and 400 patients were eligible for inclusion in the study. Patients who chose to follow up at a non-AMPATH site are excluded from the study.
Process to Implementation This intervention has not yet been implemented in Indiana but is being piloted in Kenya. If the pilot findings show positive outcomes, potential exists to apply this intervention to low resourced clinical settings in Indiana and the US. Following identification of potential pilot sites in Indiana, this intervention could be adapted and piloted for use in the US clinical context using support from the Indiana CTSI and other health partners in Indiana, e.g. State Department of Health, IU Health, Eskenazi, and other public health centers.
Key Stakeholders There were clinical partners, including doctors, nurses, etc. that helped with the intervention, patients, Ministry of Health stakeholders. We anticipate in transferring to the US that there would need to be similar stakeholders that would need to be engaged within the health systems.
Scaled or Transferred? The aim is to work toward scaling this process into the US setting
Type of Research Implementation science was utilized. Researchers collected data from April 2016 to January 2017 to determine frequencies of linkage, retention and adherence for patients who interacted with a inpatient HIV peer navigator during their admission on the Nyayo wards at MTRH. A member of the research team will access data from standardized data collection forms, AMRS, the mobile application and pharmacy dispensing tools, as appropriate for each outcome. Then descriptive statistics were generated on frequencies of linkage, retention and adherence as proof-of-concept of the inpatient peer navigator intervention.
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