Making the Link: A Pilot Health Navigation Intervention to Improve Timely Linkage to Care for Men Who have Sex with Men and Transgender Women Recently Diagnosed with HIV in Guatemala City

Abstract

Introduction: Men who have sex with men and transgender women across the globe experience barriers to timely linkage-to-HIV care. Health navigation is a strengths-based approach, originally developed for cancer patients, to address these barriers and provide support. We piloted a health navigation strategy to improve timely linkage-to-care among men who have sex with men and transgender women recently diagnosed with HIV in three sexual health clinics in Guatemala City. Methods: Participants included individuals who were at least 18 years old, identified as a cisgender man or transgender woman, reported having had sex with a man in the past 12 months, and had received a positive HIV diagnosis at one of the participating clinics. Three health navigators were trained in health navigation including: assets-based counselling and support; health system information; and advocacy. We used a combination of quantitative data collected during clinic visits and qualitative data collected through in-depth interviews with participants who accepted navigation to characterize the acceptability, effectiveness, and our primary outcome of time to linkage, defined as having the first clinical care visit. Results: Out of 61 men who have sex with men and transgender women diagnosed at the participating clinics during the study period, 54 were offered participation and enrolled in our pilot (n=52 men who have sex with men; n=2 transgender women). Fifty participants (92.6%) accepted navigation, all who accepted were successfully linked-to-care. The median time to linkage was 3 days (Interquartile Range 2–5 days). In qualitative interviews, participants expressed feeling extremely scared and alone following their diagnosis and appreciated the support of a navigator especially when they did not feel they could access their existing support networks. Conclusions: Navigation was a highly acceptable and effective strategy for facilitating timely linkage-to-care among newly diagnosed men who have sex with men at participating clinics in Guatemala City. Differentiated approaches should be used to improve engagement with transgender women. Based on these findings, navigation strategies are currently being integrated into HIV prevention and care models in the Central American region. Rigorous implementation science research and evaluation should continue to explore the use of health navigation with key populations recently diagnosed with HIV.

Timely linkage to care among men who have sex with men newly diagnosed with HIV: A structural equation model adapted from the HIV‐related stigma framework

“…The current work has implications for intervention and research. It is consistent with evidence supporting efforts to improve the quality of linkage procedures at both the community (Tanner et al, 2016) and health system (Loya‐Montiel et al, 2019) levels. Future interventions to enhance social support, reduce HIV stigma, and provide support to deal with family issues regarding the disclosure of HIV status might be useful, especially for newly diagnosed MSM.…”

Examining How Health Navigation Affects Mental Health Among Gay, Bisexual, and Other Men Who Have Sex with Men Living with Human Immunodeficiency Virus in Guatemala

“…24 To address these challenges being tested for HIV and linked to care, our team designed and implemented the first navigation pilot intervention to promote timely linkage to care in Guatemala city in 2014. 25 Based on encouraging results of the pilot and the high levels of satisfaction among participants and clinics, with participants using a mobile application (app), including mode of interaction (in-person or remote), duration of the interaction (in minutes), and content of the interaction (appointment reminder, HIV education, emotional support, etc. ).…”

“Lost trust in the system”: system barriers to publicly available mental health and substance use services for transgender women in San Francisco

“…Participants reported that peer navigation may help facilitate linkages and help address barriers. Navigation services have been successful in engaging trans women in HIV care [26]. Navigation services, and particularly peer navigators who identify as trans and work in the public health system have been shown to improve HIV care engagement and outcomes and may provide the needed bridge for trans women to link to MHSU services through the fostering of trust, the similarities in background between peer and participant and accessibility of peer navigators [26][27][28][29].…”

“…Navigation services have been successful in engaging trans women in HIV care [26]. Navigation services, and particularly peer navigators who identify as trans and work in the public health system have been shown to improve HIV care engagement and outcomes and may provide the needed bridge for trans women to link to MHSU services through the fostering of trust, the similarities in background between peer and participant and accessibility of peer navigators [26][27][28][29]. Not only can peer navigators offer support through referrals to ancillary support programs, but they can educate, provide feedback, and motivational interventions to teach about the connection between social and daily stressors with mental health and substance use and may create motivation to engage in MHSU services [28,29].…”