Abstract
Evidence suggests priorities differ between patients in HIV care and their providers regarding topics most important to address in care. At five U.S. sites, we asked patients and providers to prioritize 25 potential topic areas to address during routine visits, and invited patients to discuss selection rationale. Patients (n = 206) and providers (n = 17) showed high discordance in rank order priorities (X2 (24, 223) = 71.12; p < 0.0001). Patients ranked social domains such as HIV stigma highly; a higher proportion of providers prioritized substance use domains. HIV stigma was a higher priority for patients in care fewer than 6 years (Fisher’s exact p = 0.0062), nonwhite patients (Fisher’s exact p = 0.0114), and younger patients (Fisher’s exact p = 0.0281). Patients’ priorities differed between men and women (X2 (24, 188) = 52.89; p < 0.0001), white race vs. other races (X2 (24, 206) = 48.32; p = 0.0023), and Latinos vs. non-Latinos (X2 (24, 206) = 48.65; p = 0.0021). Interviews (n = 79) revealed perceived impact of social context on health and health behaviors.
Resumen
Las pruebas sugieren que los pacientes en tratamiento anti-VIH y los proveedores de aquél tienen prioridades distintas sobre qué aspectos más importantes abordar en el tratamiento. En cinco centros estadounidenses, pedimos a pacientes y proveedores que priorizaran 25 posibles aspectos a abordar durante las consultas de rutina, e invitamos a los pacientes a explicar los motivos de sus elecciones. Entre pacientes (n = 206) y proveedores (n = 17) hubo una disparidad alta a la hora de ordenar sus prioridades (X2 (24, 223) = 71.12; p < 0.0001). Los pacientes dieron gran importancia a los aspectos sociales, tales como el estigma asociado al VIH; una mayor proporción de proveedores dio mayor importancia a lo relativo al uso de sustancias. El estigma asociado al VIH fue una prioridad más alta para los pacientes en tratamiento durante menos de 6 años (prueba exacta de Fisher p = 0.006), pacientes de raza no blanca (prueba exacta de Fisher p = 0.0114) y pacientes más jóvenes (prueba exacta de Fisher p = 0.0281). Las prioridades de los pacientes difirieron entre hombres y mujeres (X2 (24, 188) = 52.89; p < 0.0001), raza blanca frente a otras razas (X2 (24, 206) = 48.32; p = 0.0023), y origen latino frente a no latino (X2 (24, 206) = 48.65; p = 0.0021). Las entrevistas (n = 79) realizadas revelaron una percepción del efecto del contexto social sobre la salud y los comportamientos relacionados con la salud.
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Acknowledgements
We thank our patients and the Fenway Community Health and UAB Community Advisory Boards for their insights, and we thank the Madison Clinic Patient Advisory Board for guidance in domain selection and development of the measure. This work was funded by the Patient Centered Outcomes Research Institute (PCORI) SC14-1403-14081. Additional support came from the National Institute of Allergy and Infectious Diseases (NIAID) [CNICS R24 AI067039, UW CFAR NIAID Grant P30 AI027757; and UAB CFAR Grant P30 AI027767].
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Fredericksen, R.J., Fitzsimmons, E., Gibbons, L.E. et al. How Do Treatment Priorities Differ Between Patients in HIV Care and Their Providers? A Mixed-Methods Study. AIDS Behav 24, 1170–1180 (2020). https://doi.org/10.1007/s10461-019-02746-8
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DOI: https://doi.org/10.1007/s10461-019-02746-8