HIV Navigation: A Holistic Model for Building Medical Compliance

Presenter Information

Benjamin Siegelman, Mary's Center for Maternal and Child HealthFollow
Marcia Truman, Mary's Center for Maternal and Child HealthFollow

Abstract

Using case studies from our program, we intend to describe an experiential approach to building compliance in HIV-positive patients. Participants will learn innovative strategies to improve patient access and retention to care by addressing the relationships between Health Literacy, Destigmatization, and Medical Adherence.

Proposal Summary

Non-compliance is a barrier to improved health outcomes in any HIV clinic; in a clinic serving rural populations with limited access to resources, this barrier stands doubly tall. Though situated in the heart of metropolitan Washington DC, Mary’s Center for Maternal Health serves a target population that largely comes from small, resource-poor communities around the world. In our decade of “HIV Navigation” for these populations, we’ve learned about the roots of medical compliance, and the medical, social, and psychological realities that present barriers for this goal. In this presentation, we intend to communicate this model through case studies from our clinic, discuss innovative strategies for improving access and retention to care, and analyze cases through the framework of Health Literacy, Destigmatization, and Medical Adherence. We postulate that these three factors are deeply connected to each other, particularly in under-resourced populations; and we have learned that when these factors overlap, compliance is enhanced and health outcomes improved. In our presentation, we will define these three facets of health, discuss signs by which care providers can recognize and assess problems, and share strategies for improvement. We will describe our model for care, the Social Change Model, which includes a combination of primary and behavioral health services administered by physicians, social workers, mental health professionals, Health Educators, an HIV Navigator, and an HIV Peer Wellness Advocate. Using motivational interviewing, solutions-based techniques, and behavior change tools, this team addresses Stigma, improves Health Literacy, and breaks down barriers to Medical Adherence. Three cases will illustrate this model’s success: an African-American woman diagnosed with AIDS, who had fallen out of care and stopped taking her pills; a discordant Latino couple who struggled with disclosure and compliance; and a Mexican trans-woman who came to us in need of ARVs, and who used our services to learn about and navigate the medical systems of DC. Using these examples, we will demonstrate how addressing Stigma, Health Literacy, and Medical Adherence builds a patient’s capacity for compliance, empowers individuals to understand and control their own medical experience, and ultimately leads to improved health outcomes.

Relevance And Significance

Our program may function in an urban setting, but our patients largely come from rural populations, and their understanding of HIV is shaped by the same social determinants, resource scarcity, and economic factors that define the experience of Rural HIV. We’ve built a model that combines primary and behavioral health, and that empowers patients by addressing the medical, social, and psychological realities that hinder their medical outcomes. This directly addresses the objectives of the 2015 Rural HIV Research and Training Conference, and our presentation will speak to the experiences of its participants. We believe this presentation is relevant to the Clinical Research conference track. Our program exists in the context of a Federally Qualified Health Center based in resource-poor and medically underserved communities of Washington DC & Maryland. As such, our presentation speaks to the design and implementation of chronic disease programs in any clinical setting. We will also present our findings on the development of strategies for access, retention, and care. Additionally, this presentation is relevant to the Family and Community track because it is based in social determinants of health. Stigma and Health Literacy, even at the individual level, are factors that impact the entire community. Our model is rooted in patient education, and this is a practice that inevitably spreads to family, friends, and the wider community.

Session Format

Presentation Session

Keywords

Compliance, Health Education, Navigation, Stigma, Health Literacy, Medical Adherence, Retention, Care Coordination, Health Promotions, Patient Centered Care

Publication Type and Release Option

Presentation (Open Access)

Recommended Citation

Siegelman, Benjamin and Truman, Marcia, "HIV Navigation: A Holistic Model for Building Medical Compliance" (2015). 9th Annual Rural HIV Research and Training Conference (2014-2019). 9.
https://digitalcommons.georgiasouthern.edu/ruralhiv/2015/2015/9