Moving Beyond Viral Suppression: Poor Patient-Provider Communication and Its Impact on Healthcare Outcomes Among People Living With HIV in the United States

Abstract

BackgroundWhile advancement in treatment have turned HIV into a manageable chronic condition achieving viral suppression, it has become imperative to focus on overall health and improving health-related quality of life of people living with HIV (PLHIV) beyond viral suppression. This study aimed to describe how PLHIV perceive and manage their overall health, factors influencing patient-provider communication, and the impact of poor patient-provider communication on health outcomes.MethodsThis cross-sectional, online survey recruited HIV-positive adults in the United States between February 22 and June 2, 2022, via the Profiles Panel. Data on sociodemographic and health characteristics, and social determinants of health were collected. The study assessed how PLHIV view and manage their overall health by measuring self-rated overall health, Patient Activation Measure^® (PAM^®), general and HIV-specific health locus of control (HLOC). Multivariable analyses were used to identify the barriers and unmet needs in the patient-primary HIV clinician communication.ResultsOf the 781 PLHIV who completed the study, most participants were cisgender male (56.2%), non-Hispanic, White (51.5%), and <50 years old (67.0%). Over 90% of participants reported being virally suppressed or having an undetectable viral load. About one-third (31.5%) reported their overall health as either poor or fair. Participants were highly activated in managing their health with 58.0% at PAM level 3 and 33.3% at level 4 and had high scores across the dimensions of both general and HIV-specific HLOC. Overall, 18.2% of the participants reported suboptimal satisfaction and 16.8% reported facing difficulty in verbalizing their HIV-related health concerns with their primary HIV clinician. One-fourth of the participants reported "sometimes" or "never/rarely" discussing their HIV treatment medications with their primary HIV clinician. Furthermore, participants dissatisfied with their primary HIV clinician were twice as likely to self-report poor overall health (OR: 2.2, 95% CI: 1.38, 3.48).ConclusionThis study underscores the critical role of managing overall health by optimizing patient-provider relationships in influencing individual holistic well-being beyond viral suppression. Healthcare interventions should prioritize strategies to enhance patient communication and satisfaction, recognizing its profound impact on HIV and overall health outcomes.

Keywords: AIDS; HIV; PLHIV; antiretroviral treatment; quality of life; viral suppression.

Figure 1.

Barriers and unmet needs in communication between PLHIV and primary HIV clinicians. Note: Frequency of discussing prescription medications for all other conditions excludes 257 participants who were not taking a prescription medication for any other health condition, and frequency of discussing vitamins, supplements, or OTC medications excludes 343 participants who were not taking a vitamin, supplement, or OTC medication. Abbreviations: HIV, human immunodeficiency virus; OTC, over-the-counter; PLHIV, people living with HIV.

Figure 2.

Multivariable model showing factors associated with difficulty verbalizing health concerns with primary clinician who manages HIV. Note: ORs and 95% CIs from a binary logistic generalized linear model examining factors that are associated with difficulty verbalizing health concerns with the primary clinician who manages HIV. Only factors that were statistically significant (P < .05) are shown in the figure. Age, sex at birth, sexual orientation, race/ethnicity, education, insurance, BMI, smoking status, undetectable viral load, polypharmacy, PAM score, general HLOC (MHLC-B) (internal and powerful others subscales), HIV-specific HLOC (MHLC-C) internal subscale, perceived judgment of sexual practices (I feel my clinician judges my sexual practices), psychological impact (I feel stressed trying to meet all my responsibilities such as my physical health, family and/or work), and empowering impacts of HIV diagnosis (I pay more attention to my health since my HIV diagnosis) were other variables included in the model. Respondents who selected “not listed” for sex at birth were collapsed with the reference group. Respondents who selected “another race” or “prefer not to say” were collapsed with the reference group. Abbreviations: BMI, body mass index; CI, confidence interval; LCL, lower confidence level; HIV, human immunodeficiency virus; HLOC, health locus of control; OR, odds ratio; UCL, lower confidence level.

Figure 3.

Multivariable model showing factors associated with poor overall health status (n = 781). Note: ORs and 95% CIs from a binary logistic generalized linear model examining barriers and unmet needs in patient–provider communication and other factors that are associated with poor self-rated overall health. Only factors that were statistically significant (P < .05) are shown in the figure. Difficulty of verbalizing health concerns, never to sometimes discusses HIV prescription medications with primary clinician who manages HIV, never to sometimes discusses other prescription manages with primary clinicians who manages HIV, never to sometimes discusses vitamins, supplements, or OTC medications with primary clinician who manages HIV, individual comorbidities (including cardiovascular disease, depression, gastroesophageal reflux disease (GERD), high blood pressure (hypertension)), polypharmacy, suboptimal adherence, age, sex at birth, sexual orientation, race/ethnicity, worried food would run out, undetectable viral load, and HIV-specific HLOC (MHLC-C) internal and doctors subscales were other variables included in the model. Respondents who selected “not listed” for sex at birth were collapsed with the reference group. Respondents who selected “another race” or “prefer not to say” were collapsed with the reference group. Abbreviations: CI, confidence interval; HIV, human immunodeficiency virus; HLOC, health locus of control; LCL, lower confidence level; OR, odds ratio; PAM, Patient Activation Measure; UCL, upper confidence level.