title: 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.
  
  
  BACKGROUND
  NCT01103856.
authors.affiliation: Department of Medicine.|Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
authors.affiliation: Department of Psychiatry, Baylor College of Medicine, and.|Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Cully
authors.affiliation: Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor.
authors.forename: K Rivet
authors.initials: KR
authors.lastname: Amico
authors.affiliation: Department of Medicine.|Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Davila
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kallen
authors.affiliation: Department of Medicine.|Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Christine
authors.initials: C
authors.lastname: Hartman
authors.affiliation: Harris Health System, Houston, Texas.
authors.forename: Jackie
authors.initials: J
authors.lastname: Wear
authors.affiliation: Department of Medicine.|Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: April
authors.initials: A
authors.lastname: Buscher
authors.affiliation: Department of Psychiatry, Baylor College of Medicine, and.|Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.
authors.forename: Melinda
authors.initials: M
authors.lastname: Stanley
mesh_terms: D000328:Adult; D061345:Early Medical Intervention; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008611:Mentors; D008875:Middle Aged; D010379:Peer Group; D016896:Treatment Outcome; D016903:Drug Monitoring
keywords: HIV/AIDS; adherence to care; patient navigation; peer; retention in care