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Using Causal Bayesian Networks to Assess the Role of Patient-Centered Care and Psychosocial Factors on Durable HIV Viral Suppression

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Abstract

We assessed the role of patient-centered care on durable viral suppression (i.e., all viral load test results < 200 copies per ml during 2019) by conducting a retrospective cohort study of clients medically case managed by the Miami-Dade County Ryan White Program (RWP). Summary measures of patient-centered care practices of RWP-affiliated providers were obtained from a survey of 1352 clients. Bayesian network models analyzed the complex relationship between psychosocial and patient-centered care factors. Of 5037 clients, 4135 (82.1%) had durable viral suppression. Household income was the factor most strongly associated with durable viral suppression. Further, mean healthcare relationship score and mean “provider knows patient as a person” score were both associated with durable viral suppression. Healthcare relationship score moderated the association between low household income and lack of durable viral suppression. Although patient-centered care supports patient HIV care success, wrap around support is also needed for people with unmet psychosocial needs.

Resumen

Evaluamos el rol de la atención centrada en el paciente en la supresión viral duradera (es decir, todos los resultados de las pruebas de carga viral < 200 copias por ml durante 2019) mediante la realización de un estudio de cohorte retrospectivo de clientes manejados médicamente por el Programa Ryan White del condado de Miami-Dade (RWP). Se obtuvieron medidas resumidas de las prácticas de atención centradas en el paciente de los proveedores afiliados a RWP usando una encuesta de 1352 clientes. Los modelos de redes bayesianos analizaron la relación compleja entre los factores psicosociales y de atención centrada en el paciente. De 5037 clientes, 4135 (82,1%) tenían una supresión viral duradera. Los ingresos del hogar fueron el factor asociado con la supresión viral duradera más fuerte. Además, la puntuación promedia de la relación con proveedores de atención médica y la puntuación promedia de "el proveedor conoce al paciente como persona" fueron asociados con una supresión viral duradera. La puntuación de la relación con proveedores de atención médica moderó la asociación entre los ingresos bajos del hogar y la falta de supresión viral duradera. Aunque la atención centrada en el paciente apoya el éxito de la atención médica del VIH, también se necesita un apoyo integral para las personas con necesidades psicosociales insatisfechas.

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Acknowledgements

This research was supported by the National Institute on Minority Health & Health Disparities (NIMHD), National Institutes of Health under Award Numbers R01MD012421 and R01MD013563. The authors also gratefully acknowledge the use of the services and facilities supported in part by NIMHD under Award Number U54MD012393, Florida International University Research Center in Minority Institutions. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to acknowledge the assistance of Samantha Gonzalez from Florida International University and Morela Lucas from Behavioral Science Research Corporation. In addition, the authors gratefully acknowledge the support of Carla Valle-Schwenk, Ryan White Program Administrator, and the entire Ryan White Part A Program in the Miami-Dade County Office of Management and Budget in the implementation of this study.

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Authors and Affiliations

  1. Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA

    Mary Jo Trepka, Melissa K. Ward, Diana M. Sheehan, Gladys E. Ibañez, Tendai Gwanzura, Ekpereka S. Nawfal & Aaliyah Gray

  2. Research Center for Minority Institutions, Florida International University, Miami, FL, USA

    Mary Jo Trepka, Melissa K. Ward & Diana M. Sheehan

  3. Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA

    Zhenghua Gong & Changwon Yoo

  4. Division of Natural Sciences, New College of Florida, Sarasota, FL, USA

    Kristopher P. Fennie

  5. Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA

    Michele Jean-Gilles & Jessie Devieux

  6. Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA

    Mary Catherine Beach

  7. Behavioral Science Research Corporation, Coral Gables, FL, USA

    Robert Ladner

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Trepka, M.J., Gong, Z., Ward, M.K. et al. Using Causal Bayesian Networks to Assess the Role of Patient-Centered Care and Psychosocial Factors on Durable HIV Viral Suppression. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04310-5

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