SEATTLE, WA –Patients randomized to the support of a health navigator were not more likely than those who received standard of care to complete tuberculosis treatment or begin antiretroviral therapy within three months of HIV diagnosis, according to the results of a randomized trial presented here today. Ingrid Bassett from Massachusetts General hospital reported on the outcome of the study, which enrolled 4,903 patients was at two hospital outpatient clinics and two rural primary care clinics in Durban South Africa.
The patients in the healthcare navigator arm had a baseline interview using a case management approach to identify barriers to entering care and devising solutions. They then received scheduled telephone calls and text messages over a four-month period. Less than 40 percent of the study participants eligible for antiretroviral therapy had evidence of taking antiretroviral medication or completing TB treatment at the study sites during the nine months after diagnosis. The health navigators were unsuccessful in most cases in completing the protocol of five telephone calls and four text messages because they were unable to reach the patients. Those patients who successfully connected with the health navigators were more likely to have completed tuberculosis treatment and/or have initiated HIV therapy. Thirteen percent of the patients died during the study period and there was no difference in mortality between the health navigator and standard of care groups.
Basset noted that more intensive interventions would be needed to connect these patients with lifesaving care and treatment. Ian Sanne, a South African clinician and researcher, also pointed out that there is a high “churn” of cell phone numbers in the South African setting making continuous contact with patients by phone difficult.