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Informing Targeted Interventions to Optimize the Cascade of HIV Care Using Cluster Analyses of Health Resource Use Among People Living with HIV/AIDS

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Abstract

Increased awareness of the secondary preventive benefits of antiretroviral treatment (ART) has strengthened the desire to optimize health care systems’ response to HIV/AIDS. We identified clusters of health resource utilization (HRU) among people living with HIV (PLHIV) to inform targeted interventions aimed to optimize the cascade of HIV care. Using linked population-level health databases in British Columbia, Canada, we selected two analytic samples of PLHIV with 3 years of follow-up between 2006–2011 that were classified as intermittently retained in care or intermittently engaged in ART, and executed a probabilistic model-based clustering analysis for each sample with 5 and 9 quarterly HRU variables, respectively. We found clear HRU profile differences among both samples with similar HIV-related care: one featured active involvement in non-HIV care, the other little or no health care interaction following linkage to care. Differential reengagement intervention strategies capitalizing on missed opportunities in non-HIV care and further engaging physicians delivering HIV care are needed to optimize the response to the HIV epidemic.

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Acknowledgements

We acknowledge all BC Ministry of Health (BCMoH) and Vancouver Coastal Health Decision Support Staff involved in data access and procurement, including Monika Lindegger, Clinical Prevention Services, British Columbia Centre for Disease Control; Elsie Wong, Public Health Agency of Canada; Al Cassidy, BCMoH Registries; and Joleen Wright and Karen Luers, Vancouver Coastal Health decision support.

Funding

This work was supported by the British Columbia Ministry of Health-funded ‘Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) provincial program and the Canadian HIV Observational Cohort Study (CANOC). J.S.G.M. is supported with grants paid to his institution by the British Columbia Ministry of Health and by the US NIH (R01DA036307 and 1DP1DA026182). B.N. is supported by a grant from the National Institutes of Health/National Institute on Drug Abuse (R01-DA-041747) and is a Michael Smith Foundation for Health Research Scholar.

Collaborators for the STOP HIV/AIDS Study Group

Rolando Barrios, Vancouver Coastal Health Authority; Patty Daly, Vancouver Coastal Health Authority; Reka Gustafson, Vancouver Coastal Health Authority; Perry RW Kendall, Provincial Health Officer; Gina McGowan, British Columbia Ministry of Health; Irene Day, BC Centre for Excellence in HIV/AIDS; Kate Heath, BC Centre for Excellence in HIV/AIDS; Robert S Hogg, BC Centre for Excellence in HIV/AIDS; Julio SG Montaner, BC Centre for Excellence in HIV/AIDS; Bohdan Nosyk, BC Centre for Excellence in HIV/AIDS.

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Authors and Affiliations

  1. BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 613-1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada

    Emanuel Krebs, Jeong E. Min, Rolando Barrios, Julio S. G. Montaner & Bohdan Nosyk

  2. Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Julio S. G. Montaner

  3. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

    Bohdan Nosyk

  4. Vancouver Coastal Health, Vancouver, BC, Canada

    Rolando Barrios

  5. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Ahmed M. Bayoumi

Authors
  1. Emanuel Krebs
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  2. Jeong E. Min
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  3. Ahmed M. Bayoumi
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  4. Rolando Barrios
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  5. Julio S. G. Montaner
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  6. Bohdan Nosyk
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Consortia

On behalf of the STOP HIV/AIDS Study Group

  • Rolando Barrios
  • , Patty Daly
  • , Reka Gustafson
  • , Perry R. W. Kendall
  • , Gina McGowan
  • , Irene Day
  • , Kate Heath
  • , Robert S. Hogg
  • , Julio S. G. Montaner
  •  & Bohdan Nosyk

Corresponding author

Correspondence to Bohdan Nosyk.

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Competing interest

J.M. has also received limited unrestricted funding, paid to his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare. All other authors declare no conflicts of interest.

Ethical Approval

This study received approval from the University of British Columbia/Providence Health Care Research Ethics Board. This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Collaborators of the STOP HIV/AIDS Study Group are listed in “Acknowledgements”.

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Krebs, E., Min, J.E., Bayoumi, A.M. et al. Informing Targeted Interventions to Optimize the Cascade of HIV Care Using Cluster Analyses of Health Resource Use Among People Living with HIV/AIDS. AIDS Behav 22, 234–244 (2018). https://doi.org/10.1007/s10461-017-1839-x

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  • DOI: https://doi.org/10.1007/s10461-017-1839-x

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