Impact of Patient Navigation on Retention in Care and HIV Viral Load Suppression Among Newly Diagnosed Persons Living with HIV in the Eastern Cape - South Africa

Background: Although the WHO recommends starting ART on the same day as HIV diagnosis, poor adherence and retention without adequate support can hinder this ap-proach. Patient navigation addresses this gap by offering relational and functional support, improving adherence, psychological well-being, and health outcomes. How-ever, its impact on retention in care and viral load suppression remains unclear. Objective: To analyze how patient navigation, as an intervention, influences treatment ad-herence and virological outcomes in this specific population. Methods: A randomized controlled trial (Study ID: ISRCTN99248870) compared the exposed group, which re-ceived patient navigation as an intervention, with the standard group, serving as a control for ART initiation in eligible individuals aged ≥12 with WHO Stage 1 or 2 ill-ness. The Chi-square test was employed to analyze retention in care six months post-HIV testing, with a focus on participants exhibiting HIV-1 RNA levels <50 cop-ies/mL in both groups. Results: The results reveal that the navigation group had signif-icantly higher retention in care (65%) compared to the standard group (49%) at the end of the 6-month trial, with a p-value of 0.034. For participants with a viral load of less than 50 copies/mL, retention was significantly higher in the navigation group (64%) compared to 39% in the standard group (p = 0.0025). No significant difference was observed between the two groups for viral loads between 50 and 1000 copies/mL (p = 0.88). However, for participants with a viral load above 1000 copies/mL, the nav-igation group had significantly lower retention (24.7%) than the standard group (50%, p = 0.001). Conclusion: These findings demonstrate that patient navigation signifi-cantly improves viral load suppression and retention in care. In addition, it promotes better viral load control in patients with a CD4 count ≥50 cells/mm³. These results highlight the importance of integrating patient navigation into HIV care to improve therapeutic outcomes in the Eastern Cape region of South Africa.