Examining the Preliminary Impact of the Bridge Program

Purpose: The purpose of this study was to investigate the impact of a peer-delivered intervention for adults hospitalized for HIV-related illnesses upon use of treatment and medication, and barriers to care. The Bridge Program is a peer-delivered, outreach intervention that provides advocacy, education, and emotional support for low-income, unstably housed adults with HIV, facilitates connections with medical and additional services for conditions that could impede service use (i.e. substance abuse and mental health symptoms), and provides concrete services (e.g. transportation) in order to reduce the morbidity and mortality associated with AIDS. Based upon a harm reduction approach, the Bridge Program begins with an initial meeting between a trained peer facilitator and the patient during their inpatient hospital stay to review the physicians' recommendations for follow-up care, explore concerns about treatment; and to address any other obstacles to use of services. Once discharged, the Bridge peer conducts weekly home visits to ensure that the participant is attending medical care appointments (or if not to facilitate entry) and taking their medication regimen, to address any secondary issues that may interfere with service use (e.g. substance abuse, mental illness), and to be a source of support for the individual.

Methods: The number of attended clinic visits at an outpatient medical center affiliated with the hospital was compared between Bridge participants (n=138) versus all other patients (n=2548) between 2007 and 2008. Additionally, a small sample (n=22) of Bridge clients participated in open-ended interviews about their use of medical care, and barriers to receipt of services.

Results: A test of multivariate statistics indicated a statistically significant difference between the rate of HIV/AIDS clinic attendance between patients enrolled in the Bridge program versus other patients over time (Wilks' Lambada = .97, F = 2.99, p <.001). Specifically, over the course of the 12-month period displayed the typical patient enrolled in the Bridge program attended approximately one clinic visit (range = .74 – 1.22), while the typical comparison patient attended less than half an HIV/AIDS clinic visit per month (range = .34 – .53).

Additionally, QSR N6 was used to qualitatively code the content of 22 patient interviews. Consistent with the literature, although the majority reported having a regular health provider, many reported postponing necessary medical care. Also, although most participants reported having taken HIV medications, a variety of problems with medication were reported including confusion, side effects, concurrent drug use, and selling of medications, leading to either cessation of medication or sporadic use.

Moreover, a majority of participants experienced multiple stressors including poverty, homelessness, and lack of social support, and concurrent substance abuse or mental health problems which interfered with receipt of care. However, participants credited the Bridge program with providing non-judgmental support, facilitating use of services through escorting clients to the hospital and medical appointments, providing referrals to additionally services, and medical advocacy.

Discussion: The findings of this study add insight into an innovative, peer-delivered intervention, the barriers that obstruct consistent use of treatment, and the impact of the Bridge program upon engagement in care.