A Randomized Trial to Test a Peer Mentor Intervention to Improve Outcomes in Persons Hospitalized With HIV Infection

Abstract

Background: Few interventions have been shown to improve retention in human immunodeficiency virus (HIV) care, and none have targeted the hospitalized patient. Peer mentoring has not been rigorously tested.

Methods: We conducted a randomized, controlled clinical trial of a peer mentoring intervention. Eligible adults were hospitalized and were either newly diagnosed with HIV infection or out of care. The intervention included 2 in-person sessions with a volunteer peer mentor while hospitalized, followed by 5 phone calls in the 10 weeks after discharge. The control intervention provided didactic sessions on avoiding HIV transmission on the same schedule. The primary outcome was a composite of retention in care (completed HIV primary care visits within 30 days and between 31 and 180 days after discharge) and viral load (VL) improvement (≥1 log10 decline) 6 months after discharge.

Results: We enrolled 460 participants in 3 years; 417 were in the modified intent-to-treat analysis. The median age was 42 years; 74% were male; and 67% were non-Hispanic black. Baseline characteristics did not differ between the randomized groups. Twenty-eight percent of the participants in both arms met the primary outcome (P = .94). There were no differences in prespecified secondary outcomes, including retention in care and VL change. Post hoc analyses indicated interactions between the intervention and length of hospitalization and between the intervention and receipt of linkage services before discharge.

Conclusions: Peer mentoring did not increase reengagement in outpatient HIV care among hospitalized, out-of-care persons. More intense and system-focused interventions warrant further study.

Clinical trials registration: NCT01103856.

Keywords: HIV/AIDS; adherence to care; patient navigation; peer; retention in care.

© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Figures

Figure 1.

Definition of the Mentor Approach for Promoting Patient Self-care study cohort. *Reasons not mutually exclusive. Abbreviations: BTGH, Ben Taub General Hospital; HIV, human immunodeficiency virus; mITT, modified intent to treat; TSHC, Thomas Street Health Center.

Figure 2.

Outcomes in the Mentor Approach for Promoting Patient Self-care (MAPPS) study by arm. Primary outcome and reason for failure in the MAPPS study. P value for success in the primary outcome = 0.94. Viral load (VL) success is a 6-month VL that is reduced by 1 log10 from baseline or is <400 c/mL if the baseline VL was <4000. Missing VL = failure. Retention in care (RIC) success is at least 1 primary care visit between 1 and 30 days after hospital discharge and at least 1 subsequent primary care visit between 31 and 180 days after discharge. Abbreviation: mITT, modified intent to treat.

Figure 3.

Viral load improvement by arm, stratified by length of stay (LOS) in the hospital (A) and by seeing a service linkage worker (SLW) before discharge (B), in the Mentor Approach for Promoting Patient Self-care study.