Convenience, accessibility, confidentiality and quality care. If the U.S. healthcare system is to bring people who have abandoned HIV care back to the clinic, that’s what people with HIV say they’ll have to do, according to data presented this week at the 11th annual conference. International AIDS Society on HIV Science (IAS 2021).
The United States has a major problem with engaging in HIV care. Right now, only half of people living with HIV are actively participating in care, said Kelly Dyer, a research assistant at Emory University School of Medicine, who presented the data. Only 56% of them maintain an undetectable viral load, which is associated with a longer lifespan and less disease, as well as eliminating the risk of transmitting HIV to sexual partners.
For example, Dyer and his colleagues conducted a mixed-method study between June 2019 and May 2021. One arm conducted in-depth interviews with 41 people working in HIV clinics, people living in the community and, most importantly, people living with HIV. HIV who were not currently in care. . The other arm asked 50 people living with HIV who were not undergoing treatment to participate in a survey on which of the seven models of HIV care they would prefer.
The seven models included the traditional HIV clinic and six alternatives:
- A mobile clinic
- A community center with peer navigators
- Integrate HIV care into primary care clinics
- Integrating HIV care into homeless shelters
- Integrate HIV care into drug treatment centers.
The vast majority of people living with HIV were black (86%), 82% were men, more than half (52%) were from sexual minorities, and 54% earned less than $ 10,000 per year. Out of ranked choice responses, the traditional HIV clinic model came third as the preferred model of care among people living with HIV, mobile clinics and community-based peer navigation care arriving first and respectively. second position.
Mobile clinics were by far the most popular: 70%, or 35 people living with HIV who opted out of care, ranked the mobile clinic as their first or second choice, 21 listing it as their first choice. In comparison, the traditional HIV clinic model was the first choice for only 14% of participants, or about seven people. Peer community navigators ranked first or second for 38% of participants. Fewer than 10 people cited this model as their first choice.
Interestingly, the traditional HIV clinic model was the third most popular, with 24% indicating it as the first or second choice, but 32% indicating it as the second to last choice of care – the only ranking worse. that “would never use.” “
Traditional clinic-linked telemedicine as the preferred way to receive HIV care, with one person in the interview side of the study saying it’s “more private and more convenient because I can do it at home.”
The least popular option was to receive HIV care at drug treatment centers, with only one listing it as their first choice and 18% saying they would never use this type of care. It is not known if it is because they do not report problematic drug use.
The heterogeneity of preferences means that more than one method may be needed to fully involve all people living with HIV in care. Since this is a very small study population, the results should be taken with great caution.
“Through this work, what we have learned is that there is no one size fits all when it comes to caregiving, highlighting the need to provide multiple alternative delivery models,” said Dyer. “In addition, several participants discussed the need to integrate models of care and for individuals to choose different models of care at different times.”
Click here to read the study summary.
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