One size does not fit all: Preferences for HIV care delivery among out-of-care people living with HIV in the Southeastern United States

Abstract

Approximately half of the people with HIV (PWH) in the United States are retained in HIV care and only 57% have achieved viral suppression, due to barriers including transportation access, stigma, poor mental health, substance use, and medical mistrust. Community-based HIV care models have potential to address the diverse needs of patients and to improve retention in care, but their success is contingent on acceptance by patients and key community stakeholders. Recognizing that the preferences of PWH who are out-of-care (PWH-OOC) likely differ from those retained in care, we conducted a mixed-methods study from June 2019 to May 2021 composed of surveys with PWH-OOC (n = 50) and in-depth interviews with key clinic and community stakeholders (n = 41) to examine the relative preference and perceived advantages and disadvantages for six different community-based HIV care models versus the traditional fixed-clinic model. Survey data was analyzed to assess average rank preference for each care model and interview transcripts were thematically coded to examine factors influencing model acceptance. The highest preference for care delivery was via a mobile clinic, followed by community-based peer navigation, primary care clinics, telemedicine, traditional HIV subspeciality clinic, homeless shelter, and drug treatment center. Common factors influencing preference included convenience, accessibility, potential to preserve confidentiality, quality of care assurance, opportunity to develop rapport with their HIV care provider, access to a smart device, and potential to alleviate versus exacerbate HIV stigma. Participants discussed need for integration of care models and for individuals to choose different care models at different times. Providers and patients differed in preference for care model and weighting of relative advantages and disadvantages of each. Findings highlight the need to integrate alternative, community-based care models into the national plan to end the HIV epidemic and to allow for PWH-OOC to choose the model most fitting based on individual circumstances.

Quality of Nursing Care Perceived by People With HIV in Brazil: A Cross-Sectional Study

“…Several studies (Jones et al, 2023;Krabbenborg et al, 2021) emphasize the concern of most PWH about the privacy and confidentiality of the diagnosis and the provision of care, whether unintentional (when the transmission of information is interconnected to administrative procedures) or intentional (when health-related aspects of a For the purposes of association analyses, the variable "race" was dichotomized into "Black" and "other races" (White, Brown, and Indigenous).…”

“…et al, 2022). Furthermore, PWH value attentive and friendly professionals who build trust (Jones et al, 2023;Krabbenborg et al, 2021).…”

“…Several studies (Jones et al, 2023; Krabbenborg et al, 2021) emphasize the concern of most PWH about the privacy and confidentiality of the diagnosis and the provision of care, whether unintentional (when the transmission of information is interconnected to administrative procedures) or intentional (when health-related aspects of PWH are revealed to family members and other people not involved in the care process; Bayisa et al, 2022). It was observed that PWH start HIV management later if they feel a lack of confidence in the professional regarding the confidentiality of the diagnosis and health status (Bayisa et al, 2022).…”

“…It was observed that PWH start HIV management later if they feel a lack of confidence in the professional regarding the confidentiality of the diagnosis and health status (Bayisa et al, 2022). Furthermore, PWH value attentive and friendly professionals who build trust (Jones et al, 2023; Krabbenborg et al, 2021).…”