Brief, Patient-Reported Engagement Survey Associated With Virologic Control Among Patients With HIV

A 10-item, patient-reported index for patients with HIV was associated with viral suppression (VS) and retention. These findings, from a cohort study, were published in Clinical Infectious Diseases.

Researchers recruited patients from 8 HIV clinics in the United States. Patient medical records (N=3398) were combined with patient-reported outcomes and collected every 4-6 months. Between 2016 and 2017, the 10-item Index was added to the patient-reported outcome assessment.

The Index assessed patient comfort with and trust of their healthcare provider. Each of the 10 items were scored on a 5-point Likert scale and total scores were averaged.

Over half of patients were aged 50 years or older (53%), 78.6% identified as cis-gendered men, 19% identified as cis-gendered women, 44.3% were White, 41% were Black, 34% identified as heterosexual, and 10% had unsuppressed viral load. Patients had been participating in this cohort study for a median of 7.04 years (interquartile range [IQR], 3.1-12.3), and the mean Index score was 4.5.

Among the 2736 participants with adequate follow-up and complete data, the median number of scheduled appointments was 4 (IQR, 2-6) and 75% of appointments were attended by 70% of patients. The median viral load measured at attended appointments was 2 (IQR, 1-3) and 19% of patients had a least 1 unsuppressed measurement.

Unsuppressed viral load was associated with Index score (adjusted odds ratio [aOR], 0.48; 95% CI, 0.31-0.73; P =.001) and time spent participating in this study cohort (aOR, 0.95; 95% CI, 0.90-1.00; P =.05).

Missing appointments was associated with younger age (18-29 years; aOR, 2.94; 95% CI, 2.35-3.68; P <.0001), ethnicity (Black; aOR, 1.51; 95% CI, 1.26-1.80; P <.0001), time spent participating in this cohort study (aOR, 0.97; 95% CI, 0.95-0.98; P <.0001), and Index score (aOR, 0.69; 95% CI, 0.61-0.77; P <.0001).

Index score was associated with retention and viral load.

This study may have been limited by its study population, which had an established relationship with their care providers and a relatively high rate of viral suppression and retention.

These data indicated a brief screening tool, the Index, effectively gauged patient engagement and had the potential to allow for early intervention to improve patient attitudes or to identify patient concerns.

Reference

Christopoulos K A, Neilands T B, Koester K A, et al. The HIV index: using a patient-reported outcome on engagement in HIV care to explain sub-optimal retention in care and virologic control. Clin Infect Dis. 2020;ciaa1892. doi:10.1093/cid/ciaa1892.