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Intervention IP-094: LINK LA: Effectiveness of Peer Navigation to Link Released Jail Inmates with HIV to HIV Care

Summary

This intervention used peer navigation for post-release viral suppression for incarcerated people living with HIV in LA. The in-person intervention occurred over 24 weeks, 12 sessions, by trained peer navigators that coached participants on goal setting and problem-solving barriers to HIV care starting in jail and after release. Probability of viral suppression among controls declined from 52% at baseline to 30%, while the intervention group maintained suppression at 49%. Thus, the intervention was successful at preventing declines in viral suppression after release from incarceration.

Overview

Purpose of Intervention:

LINK LA (Linking Inmates to Care in Los Angeles) is a 12-session, 24-week peer-navigation intervention for people with HIV who are scheduled to be released from jail.

Intervention Type:

Research-Tested — Interventions with strong methodological rigor that have demonstrated short-term or long-term positive effects on one or more targeted health outcomes to improve minority health and/or health disparities through quantitative measures; Studies have a control or comparison group and are published in a peer-review journal; No pilot, demonstration or feasibility studies.

Intervention Details

Intervention was Primarily Driven, Led, or Managed by:

Both Community and Academic/Clinical Researchers

Citations:

Cunningham WE, Weiss RE, Nakazono T, Malek MA, Shoptaw SJ, Ettner SL, Harawa NT. Effectiveness of a Peer Navigation Intervention to Sustain Viral Suppression Among HIV-Positive Men and Transgender Women Released From Jail: The LINK LA Randomized Clinical Trial. JAMA internal medicine. 2018 Apr 1;178(4):542-553. PubMed PubMed Central DOI
Relevance: Main Intervention, Post-Intervention Outcomes, Evaluations and Assessments
Takada S, Ettner SL, Harawa NT, Garland WH, Shoptaw SJ, Cunningham WE. Life Chaos is Associated with Reduced HIV Testing, Engagement in Care, and ART Adherence Among Cisgender Men and Transgender Women upon Entry into Jail. AIDS and behavior. 2020 Feb;24(2):491-505. PubMed PubMed Central DOI
Relevance: Evaluations and Assessments
Harawa NT, Amani B, Rohde Bowers J, Sayles JN, Cunningham W. Understanding interactions of formerly incarcerated HIV-positive men and transgender women with substance use treatment, medical, and criminal justice systems. The International journal on drug policy. 2017 Oct;48:63-71. Epub 2017 Aug 9. PubMed PubMed Central DOI
Relevance: Evaluations and Assessments

Adaptation of Another Research-based Intervention:

Contact Information

Primary Contact Name:

Dr. Nina Harawa

Primary Contact Affiliation:

UCLA

Intervention URL:

Not available

Primary Contact Email:

nharawa@mednet.ucla.edu

Primary Contact Phone Number:

310-794-8078

Results

Intentions

Improve minority health or the health of other populations with health disparities (e.g. rural populations, populations with low SES, and sexual and gender minorities)

Intervention Primary Outcome:

Improved HIV viral suppression (<75 copies/mL) over a 12-month period among people with incarceration history

Intervention Secondary Outcome:

Improved linkage to, retention in, and re-engagement in HIV care among people with incarceration history

Key Findings:

SUPPRESSION: 1) LINK LA intervention participants were significantly more likely to be virally suppressed at 12 months after jail release than transitional case management participants (49% vs 30%, probability difference = 19%, 95% CI=2-40%, p=0.03); 2) There was a significant difference-in-difference of viral suppression probability over 12 months between LINK LA intervention participants and transitional case management participants (difference-in-difference=22%, 95% CI=3%-41%, p=0.02).
CARE ENGAGEMENT: 1) LINK LA intervention participants were significantly more likely to be linked to HIV case from baseline to 6 months after jail release than transitional case management participants (89% vs 77%, difference=12%, 95% CI=4%—22%, p=0.01); 2) LINK LA intervention participants were significantly more likely to be retained in HIV care at 12 months after jail release than transitional case management participants (probability difference=0.71 visits, 95% CI=0.01-1.40, p=0.047).

Statistical Method Used:

We examined the effect of the peer navigation intervention on viral suppression using intention-to-treat, generalized linear mixed models for longitudinally measured data. All models included random intercepts for participants and used a logistic link for viral suppression and all binary outcomes.

Evaluations and Assessments

Were Any of the Following Assessments Conducted (Economic Evaluation, Needs Assessment, Process Evaluation)?:

Demographic and Implementation Description

Diseases, Disorders, or Conditions:

Substance Use/Abuse, HIV/AIDS

Race/Ethnicity:

African American or Black, Hispanic or Latino, White

Populations with Health Disparities:

People with Lower Socioeconomic Status (SES), Racial and Ethnic Minority Populations

Age:

Adults

Socio-demographics / Population Characteristics

Community Type:

Urban / Inner City

Other Populations with Health Disparities:

Prisoners / Ex-prisoners / Returning Citizens, People Living with HIV/AIDS, People Who Are Homeless, People Who Misuse Drugs and Alcohol

Gender Identity:

Male, Transgender

Sexual Orientation:

Unspecified

Geographic Location:

California

Socio-Economic Status:

Low SES

Minority Health and Health Disparities Research Framework

		Levels of Influence
		Individual	Interpersonal	Community	Societal
Determinant Types	Biological			✔
	Behavioral	✔
	Physical / Built Environment	✔
	Sociocultural Environment	✔
	Health Care System	✔

Community Involvement

The community's role in different areas of the Intervention (Choices are "No Role", "Participation", and "Leadership"):

Design:

Participation

Dissemination:

Participation

Evaluation:

Participation

Implementation:

Participation

Outreach:

Participation

Planning :

Participation

Recruitment:

Participation

Sustainability:

Participation

Characteristics and Implementation

Intervention Focus Area:

Behavior Change, Patient-Clinician Communication

Disease Continuum:

Secondary Prevention, Treatment

Delivery Setting:

Clinic / Health Care Facility, Criminal Justice System, Home

Mode of Delivery:

In-person

Who delivered the Intervention?:

Peer(s)

Conceptual Framework

Intervention Theory:

Social Cognitive / Social Learning Theory

Intervention Framework:

Social Determinants of Health Conceptual Framework

Implementation

Intervention Study Design:

Individual Randomized Controlled Trial/Comparative (requires random assignment, a control/comparison group, and pre and post intervention outcome assessments)

Targeted Intervention Sample Size:

356

Actual Intervention Sample Size:

356

Start Year:

2012

End Year:

2016

Intervention Exposures

Duration of Intervention/How Long it Lasted:

4-6 months

Frequency of Intervention Delivery:

Weekly

Number of Sessions/Meetings/Visits/Interactions:

More than 10 Sessions

Average Length of Each Session/Meeting/Visit/Interaction:

Less than 1 Hour

Format of Delivery:

Individual

Highest Reading Level of Intervention Materials Provided to Participants:

Grade 6-7

Impact, Lessons, Components

Produced an impact or change beyond the primary or secondary outcome:

Not Tested

Essential Aspects for Success:

Providing bus tokens to participants to go to HIV care appointments was helpful in ensuring continued treatment engagement. Transportation services such as Lyft may further improve these outcomes.

Intervention Impact:

Not available

Lessons Learned

Key Lessons Learned and/or Things That Could be Changed or Done Differently:

With the advent of mobile health delivery, the dose of the intervention can be more readily increased and strengthened without incurring cost to the participant or the implementation team. Therefore, some parts of the LINK LA intervention may be modified to be delivered remotely.

Insights Gained During Implementation

Insight Category	Insight Description
Equipment / Technologies	The LINK LA intervention provided cell phones to participants to improve communication with navigation staff.
Transportation	Providing bus tokens to participants to go to HIV care appointments was helpful in ensuring continued treatment engagement. Transportation services such as Lyft may further improve these outcomes.

Intervention Components

Intervention Has Multiple Components:

Assessed Each Unique Contribution:

N/A

Products, Materials, and Funding

Expertise, Partnerships, and Funding Sources

	Used for Implementation	Needed for Sustainability
Expertise
Patient Navigation	Yes	Yes
Partnerships
Government agencies (city/state/county health department, law enforcement/criminal justice agencies)	Yes	Yes
Funding Sources
Public funding (e.g., federal, state or local government)	Yes	No

Product/Material/Tools

	Tailored For Language	Language(s) if other than English	Material
Outreach/Recruitment Tools
Informed Consent Form	Yes	Spanish	Attachment available for request at the bottom of the page.
Informed Consent Form	Yes	Spanish	Attachment available for request at the bottom of the page.
Participant Educational Tools
Intervention visual aids	No		Attachment available for request at the bottom of the page.
Measurement Tools
Standardized Instrument/Measures	Yes	Spanish	Attachment available for request at the bottom of the page.
Standardized Instrument/Measures	Yes	Spanish	Attachment available for request at the bottom of the page.

Implementation Materials and Products

	Material
Implementation/Delivery Materials
No Implementation/Delivery Materials provided.
Implementation/Output Materials
No Implementation/Output Materials provided.

Articles Related to Submitted Intervention

	Article
Reports/Monographs
No Reports/Monographs provided.
Additional Articles
No Additional Articles provided.

Materials Available for Request

LINK LA Consent form 2012-10-12-SPA FINAL.doc
LINK LA Consent form.doc
LINK LA -- lntervention visual aids.docx
LINK LA Instrument (Baseline - English).doc
LINK LA Instrument 2012-09-24 v43-SP_SP_Final.docx