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)

​While incarcerated, people living with human immunodeficiency virus (HIV) infection receive antiretroviral therapy and achieve viral suppression more consistently than after they are released. This study tested a peer navigation intervention project (Linking Inmates to Care in Los Angeles, or LINK LA) versus standard transitional case management controls in helping 356 Los Angeles County Jail adult inmates sustain viral suppression after jail release.

During the 12-session, 24-week LINK LA Peer Navigation intervention, trained peer navigators counseled participants on goal setting and problem solving around barriers to HIV care and adherence, starting while the participants were still in jail. After their release, they continued counseling while they accompanied participants to 2 HIV care visits, then facilitated communication with clinicians during visits. At 12 months, viral suppression was achieved by 62 (49.6 percent) of 125 participants in the peer navigation (intervention) group compared with 45 (36.0 percent) of 125 in the transitional case management (control) group, for an unadjusted treatment difference of 13.6 percent. In the repeated measures, random effects, logistic model the adjusted probability of viral suppression declined from 52 percent at baseline to 30 percent among controls, while those in the peer navigation arm maintained viral suppression at 49 percent from baseline to 12 months, for a difference-in-difference of 22 percent.

• William E. Cunningham, MD, MPH
• Nina T. Harawa, Ph.D., M.P.H.
• Susan L. Ettner, PhD
• et al