Provider preferences for delivery of HIV care coordination services: results from a discrete choice experiment

Abstract

Introduction: The PROMISE study was launched in 2018 to assess and document the implementation of changes to an existing HIV Care Coordination Programme (CCP) designed to address persistent disparities in care and treatment engagement among persons with HIV in New York City. We evaluated provider endorsement of features of the CCP to understand drivers of engagement with the programme.

Methods: We used a discrete choice experiment to measure provider endorsement of four CCP attributes, including: (1) how CCP helps with medication adherence, (2) how CCP helps with primary care appointments, (3) how CCP helps with issues other than primary care and (4) where CCP visits take place (visit location). Each attribute had three to four levels. Our primary outcomes were relative importance and part-worth utilities, measures of preference for the levels of the four CCP program attributes, estimated using a hierarchical-Bayesian multinomial logit model. All non-medical providers in the core CCP positions of patient navigator, care coordinator and programme director or other administrator from each of the 25 revised CCP-implementing agencies were eligible to participate.

Results: We received responses from 152 providers, 68% of whom identified as women, 49% identified as Latino/a, 34% identified as Black and 60% were 30-49 years old. Visit location (28.6%, 95% confidence interval [CI] 27.0-30.3%) had the highest relative importance, followed by how staff help with ART adherence (24.3%, 95% CI 22.4-26.1%), how staff help with issues other than primary care (24.2%, 95% CI 22.7-25.7%) and how staff help with primary care appointments (22.9%, 95% CI 21.7-24.1%). Within each of the above attributes, respectively, the levels with the highest part-worth utilities were home visits 60 minutes from the program or agency (utility 19.9, 95% CI 10.7-29.0), directly observed therapy (utility 26.1, 95% CI 19.1-33.1), help with non-HIV specialty medical care (utility 26.5, 95% CI 21.5-31.6) and reminding clients about and accompanying them to primary care appointments (utility 20.8, 95% CI 15.6-26.0).

Conclusions: Ongoing CCP refinements should account for how best to support and evaluate the intensive CCP components endorsed by providers in this study.

Keywords: HIV; New York City; adherence; antiretroviral therapy; care coordination; discrete choice experiment.

Figure 1

Example of discrete choice experiment (DCE) task presented to providers (desktop or laptop browser orientation). Abbreviations: ART, antiretroviral therapy; DOT, directly observed therapy; SSI, Supplemental Security Income, a federal programme that provides monthly payments to people with income below certain financial limits

Figure 2

Part‐worth utilities^† from a discrete choice experience among providers in New York City assessing preference for HIV care coordination programme features. ^†Part‐worth utilities were estimated using effects coding and are zero‐centred. Abbreviations: ART, antiretroviral therapy; SSI, Supplemental Security Income, a federal programme that provides monthly payments to people with income below certain financial limits.