Brief Report: Understanding Preferences for HIV Care Among Patients Experiencing Homelessness or Unstable Housing: A Discrete Choice Experiment

Abstract

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.

Patients’ preferences for antiretroviral therapy service provision: a systematic review

“…Therefore, 34 articles were assessed for eligibility. From these, 11 articles were excluded: three were abstracts without full text [ 26 – 28 ], three were review articles focusing on general HIV services [ 14 – 16 ], one study assessed HIV infected pregnant women [ 29 ], one study was repeated publication [ 30 ], one primary study focused on general HIV service [ 31 ], one study assessed General practitioner or HIV clinic appointment [ 32 ], and one study assessed medical and psychosocial support [ 33 ]. Finally, 23 studies were included in the review.…”

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

“…The attribute included the current location of the POP-UP program (a clinic visit with my team at Ward 86) or the option to have a clinic visit with my team at either Ward 86 or a location in the Tenderloin, which is a neighborhood of San Francisco that has more than 1500 PWH 23 and a high prevalence of homelessness. 24 Finally, we included drop-in vs scheduled visits and incentives, which are known to be preferred among this population based on findings from a previous DCE, 5 to understand trade-offs between these preferred attributes and other newly included attributes.…”

“…A previous DCE found that participants preferred having providers who know them as a person. 5 To better understand preferences for provider continuity and trade-offs between this feature and other program features, we asked participants to select between single and a group of providers, defined as seeing the same provider or a small group of providers who work together for my care. To evaluate preferences for flexibility in care location, we included the option of accessing care with the Ward 86 care team at a second site.…”

Advancing long-acting and extended delivery HIV prevention and treatment regimens through behavioural science: NIH workshop directions

“…Community-based health services may benefit some users, whereas individuals facing many challenges may need more frequent clinical contact and psychosocial support. Clinics that provide 'on demand' and integrative care have been able to effectively retain populations with extensive adherence barriers [44,45]. These approaches could be expanded as LAED regimens are used to engage more people in HIV prevention and treatment.…”