Brief Report: Understanding Preferences for HIV Care Among Patients Experiencing Homelessness or Unstable Housing: A Discrete Choice Experiment
| Autor: | Madellena Conte, Ingrid Eshun-Wilson, Monica Gandhi, Angelo Clemenzi-Allen, Elvin Geng, Elizabeth Imbert, Matthew D. Hickey, Diane V. Havlir |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Human immunodeficiency virus (HIV) MEDLINE HIV Infections Discrete choice experiment 030312 virology medicine.disease_cause Logistic regression Choice Behavior Article 03 medical and health sciences Phone medicine Humans Pharmacology (medical) 0303 health sciences business.industry Personal relationship Patient Preference Middle Aged Patient preference Confidence interval Infectious Diseases Family medicine Ill-Housed Persons HIV-1 Housing Female business Delivery of Health Care |
| Zdroj: | J Acquir Immune Defic Syndr |
| ISSN: | 1525-4135 |
| Popis: | Background Homelessness and unstable housing (HUH) negatively impact care outcomes for people living with HIV (PLWH). To inform the design of a clinic program for PLWH experiencing HUH, we quantified patient preferences and trade-offs across multiple HIV-service domains using a discrete choice experiment (DCE). Methods We sequentially sampled PLWH experiencing HUH presenting at an urban HIV clinic with ≥1 missed primary care visit and viremia in the last year to conduct a DCE. Participants chose between 2 hypothetical clinics varying across 5 service attributes: care team "get to know me as a person" versus not; receiving $10, $15, or $20 gift cards for clinic visits; drop-in versus scheduled visits; direct phone communication to care team versus front-desk staff; and staying 2 versus 20 blocks from the clinic. We estimated attribute relative utility (ie, preference) using mixed-effects logistic regression and calculated the monetary trade-off of preferred options. Results Among 65 individuals interviewed, 61% were >40 years old, 45% White, 77% men, 25% heterosexual, 56% lived outdoors/emergency housing, and 44% in temporary housing. Strongest preferences were for patient-centered care team [β = 3.80; 95% confidence interval (CI): 2.57 to 5.02] and drop-in clinic appointments (β = 1.33; 95% CI: 0.85 to 1.80), with a willingness to trade $32.79 (95% CI: 14.75 to 50.81) and $11.45 (95% CI: 2.95 to 19.95) in gift cards/visit, respectively. Conclusions In this DCE, PLWH experiencing HUH were willing to trade significant financial gain to have a personal relationship with and drop-in access to their care team rather than more resource-intensive services. These findings informed Ward 86's "POP-UP" program for PLWH-HUH and can inform "ending the HIV epidemic" efforts. |
| Databáze: | OpenAIRE |
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