Randomized clinical trial of a community navigation intervention to improve well-being in persons living with HIV and other co-morbidities

ABSTRACT

Long-term survival of people living with HIV (PLWH) is associated with the development of co-morbid conditions and need for symptom management and other efforts to enhance quality of life. We conducted a longitudinal, randomized trial over 36 months to evaluate the effect of a community-based navigator intervention to provide early palliative care to 179 PLWH and other chronic conditions. Outcomes included quality of life, symptom management, coping ability, social support, self-management, and completion of advance directives. Data were analyzed using SAS mixed effects model repeat measurement. Our navigator program showed variable improvement over time of three outcome variables, self-blame, symptom distress, and HIV self-management. However, the program did not improve overall quality of life, social support, or completion of advance directives.

KEYWORDS:

• HIV/AIDS
• multimorbidity
• palliative care
• symptom management
• community-based health care

Acknowledgements

We wish to thank our participants, caregivers and staff at the Special Immunology Unit at University Hospitals Cleveland Medical Center; MetroHealth Hospital, Cleveland, OH; Care Alliance, Cleveland OH; the Center for AIDS Research, Cleveland, OH and our community partner, Hospice of the Western Reserve, Cleveland, OH. We are grateful also to Benigno Rodriguez, MD, Carrie Rodd, MA, Patricia Brandt, BS, Usha Vyas, BS, Jackson Currie, and Nahida Gordon, PhD for their valuable project assistance. Special thanks are due our clinical Navigators, Thomas Quinn, APRN, Michele Specht, LSW, Jennifer Martnick, APRN, Michelle Dean and Christina Guarnieri. The data instruments/measures used for this study were managed using REDCap Grant Number UL1TR000114 from the National Center for Advancing Translational Sciences (NCATS) of the NIH. The authors of this article are solely responsibility for its content. Views presented do not necessarily represent official views of the NIH/NINR/NCATS.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the National Institutes of Health (NIH), National Institute of Nursing Research (NINR), Grant #NR014059, #NR018391, Jacquelyn Slomka, PhD, RN, Principal Investigator.