Background:
Black and Hispanic Sexual and Gender Minorities (SGM) are highly impacted by HIV. Significant structural determinants of health, such as access to care, are major drivers of status neutral care engagement, an ending the epidemic imperative. We designed an insurance navigation intervention – NICE (Navigating Insurance Coverage Expansion) – that tested the impact of navigation at the point of community HIV testing and evaluated the effects of the intervention on successful insurance enrollment and linkage to status neutral care among SGMs.
Methods:
NICE aimed to test whether providing in-person assistance (enrolling, changing or learning how to use health insurance), at the HIV testing event would improve linkage rates for participants, particularly among persons living with HIV (PLWH). Black/Hispanic SGM aged 18 or older and living in Chicago were enrolled at community outreach testing events and randomized to NICE versus standard of care. Logistic regression was performed to see if there were differences in HIV linkage, PrEP linkage, and/or both (status neutral) by intervention assignment.
Results:
A total of 630 participants were enrolled, with 281 in the health insurance enrollment assistance arm and 349 in the control, with a third of the sample living with HIV (29.2%), trans* representing 8.1%, and a sizeable proportion insured at baseline (68.4%). There were no differences in sociodemographic factors at baseline across study conditions. Overall, about 46.7% PLWH were linked to care (OR 1.37, 95% CI 0.74-2.48, p=0.32), while only 16.5% for those HIV negative who attended PrEP providing clinic within 90 days (OR 0.84, 95% CI 0.50-1.43, p=0.53), however, not significant by intervention condition. Overall, about a quarter of participants were considered linked (25.8%) and there were no differences in status neutral outcomes across conditions when analysis was limited to the uninsured.
Conclusions:
Health insurance navigation, while likely an important component in accessing status neutral care, did not significantly impact linkage to care. Overall, linkage was low among SGM who had high rates of insurance at baseline. Future research should examine SGM understanding of their insurance and the ways in which it impacts their care decision making (e.g. obtaining prescribed medications, clinic choice) as well as how insurance navigation might impact care engagement in states newly adopting Medicaid or where insurance rates are low among minoritized SGM.