A Community Located Insurance Navigation Intervention to Link Sexual and Gender Minorities in Status Neutral Care: Results From the Navigating Insurance Coverage Expansion Randomized Controlled Trial.

BACKGROUND

Black and Hispanic/Latino sexual gender minorities are disproportionately affected by HIV. Structural determinants of health, such as health insurance coverage, drive care engagement and improve HIV care outcomes.

METHODS

Black and Hispanic/Latino sexual gender minorities and transgender persons ≥18 years of age, living in Chicago, IL, were enrolled and randomized to receive health insurance navigation (intervention) or standard of care. Primary and secondary outcomes were analyzed using 2-way contingency analyses to compare linkage-to-care rates by HIV status (HIV positive and HIV negative) and under a status-neutral framework, based on intervention assignment.

RESULTS

We enrolled 625 participants: 278 (44%) in the intervention arm and 347 (56%) in the control arm, with no substantial sociodemographic differences between study conditions. Overall, 29.7% were persons living with HIV, 14.1% identified as transgender, and 68.5% were insured. Among persons living with HIV in both study arms, 66.1% were linked to HIV care. Among participants living without HIV, in both study arms, 23.9% were linked to pre-exposure prophylaxis. Across study arms and HIV status, approximately one-third of participants (35.2%) were linked to care.

CONCLUSIONS

We found the provision of health insurance navigation before a care visit did not significantly improve linkage to care, even among participants not insured at study enrollment. This could partially be explained by the high prevalence of insurance at baseline.