Brief Report: Heterogeneous Preferences for Care Engagement Among People With HIV Experiencing Homelessness or Unstable Housing During the COVID-19 Pandemic

Abstract

Background/Setting: In San Francisco, HIV viral suppression is 71% among housed individuals but only 20% among unhoused individuals. We conducted a discrete choice experiment at a San Francisco public HIV clinic to evaluate care preferences among people living with HIV (PLH) experiencing homelessness/unstable housing during the COVID-19 pandemic.Methods: From July to November 2020, we conducted a discrete choice experiment among PLH experiencing homelessness/unstable housing who accessed care through (1) an incentivized, drop-in program (POP-UP) or (2) traditional primary care. We investigated 5 program features: single provider vs team of providers; visit incentives

Client preferences for HIV Care Coordination Program features in New York City: latent class analysis of a discrete choice experiment

“…Though the COVID‐19 pandemic undeniably has changed the way healthcare and support services are delivered, and may have increased the adoption of virtual options, there was already a positive preference for telehealth among responses submitted before the pandemic. This finding builds on prior research of preferences among PWH, which have shown endorsement for provider continuity and additional clinic locations [24]. The present study supports telehealth as a preferred option for CCP services, particularly with the accelerated adoption of telemedicine during the pandemic [25, 26].…”

Identifying Implementation Determinants and Strategies for Long-Acting Injectable Cabotegravir-Rilpivirine in People with HIV Who Are Virally Unsuppressed

“…Other context-specific facilitators included an existing culture of support for developing and implementing novel programs at Ward 86, including the RAPID program to implement and disseminate same-day ART initiation practices, 26–28 the Golden Compass program for older adults with HIV, 29,30 and the POP-UP program for people experiencing homelessness or unstable housing. 19,31–34…”

“…Other context-specific facilitators included an existing culture of support for developing and implementing novel programs at Ward 86, including the RAPID program to implement and disseminate same-day ART initiation practices, [26][27][28] the Golden Compass program for older adults with HIV, 29,30 and the POP-UP program for people experiencing homelessness or unstable housing. 19,[31][32][33][34] Table 4 describes outer context determinants of LA-CAB/RPV implementation identified based on experience at to err on the side of taking them" Reduces the onus of daily oral ART "Well, getting my medication in my body and in my system and not having to -not being responsible for it, myself" "For one, I wouldn't have to worry about, 'did I take my medicine?'" "So, you know, I had my medication and I was taking it every day like I was supposed to.…”

Which Features of Telehealth in HIV Care Are Most Important? A Mixed-Methods Study With HIV Care Providers and People Living With HIV in South Carolina

“…This aligns with existing literature, highlighting the impact of familiarity on trust and comfort in telehealth use, potentially influenced by experiences with or fear of stigma and discrimination. 9,[16][17][18] Future research should further explore the significance of the patient-provider relationship compared with other telehealth aspects and trade-offs PLWH are willing to make.…”

“…Telehealth modalities vary by communication type (video, voice, text), provider consistency, and scheduling 9 . To our knowledge, only one study assessed preferences for HIV care telehealth modalities among PLWH: Imbert et al 9 found heterogeneous visit modality preference profiles within their study sample, PLWH experiencing unstable housing; however, no preference profile favored telehealth over in-person care. The observed preference heterogeneity mirrored that reported in non–HIV-related literature 10 …”