Study: Homeless Persons with HIV Prefer Flexible Care Models, No Telehealth

Perspective gained from persons treated a real-world clinic may help better inform strategies to treat an HIV population that often struggles with viral suppression and consistent care.

Patients with HIV who received treatment from a San Francisco drop-in, incentivized care program for homeless or unstably-housed patients shared diverse feedback on their preferred HIV care model, according to a new study.

The findings, presented at the International AIDS Society (IAS) 2021 Conference on HIV Science this weekend, did show one interesting consistency among the population, however: telehealth services were not preferred, even during the COVID-19 pandemic.

Presented by study author Elizabeth Imbert, MD, MPH, associate professor at UCSF and clinical lead of the trial’s POP-UP Program at Ward 86, the 115-participant discrete choice experiment provided a detailed yet vital scope of patient perspective in a region where less than 40% of all people with HIV experiencing homelessness or unstable housing have achieved viral suppression.

In an interview with Contagion during IAS 2021, Imbert explained the particular motivations of the trial, which combined patient feedback on care models, physician continuity, telehealth resourcing, and incentive-based care.

“We really wanted to go back and ask patients, ‘How should we change? How should we think about telehealth? Is that going to work for you or not?’” she explained.

The leading take-home message, Imbert said, was as simple as this: HIV care preferences among unstably-house patients differs.

“Some people want a more flexible model, some people want the same doctor,” Imbert explained. “So I think we need to really think about service models that really allow for provider continuity, but also have enough flexibility that people can tailor their preferences among all the other things we provide.”

The lack of telehealth buy-in—at a time when worry for severe COVID-19 risk among patients with HIV was raised, no less—more so spoke to the strength of programs such as Imbert’s in the first place.

“This is really telling that people want in-person care, and even when these big structural things happen like COVID, we need to be able to serve people and do it in a way that they want and will be successful for them,” she said.