Informing Targeted Interventions to Optimize the Cascade of HIV Care Using Cluster Analyses of Health Resource Use Among People Living with HIV/AIDS

• Published in: AIDS and behavior Vol. 22; no. 1; pp. 234 - 244
• Main Authors: Krebs, Emanuel, Min, Jeong E., Bayoumi, Ahmed M., Barrios, Rolando, Montaner, Julio S. G., Nosyk, Bohdan
• Format: Journal Article
• Language: English
• Published: New York Springer US 2018; Springer Nature B.V
• Subjects: Acquired immune deficiency syndrome; Adult; Aged; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; British Columbia - epidemiology; Cluster Analysis; Clustering; Female; Health care; Health Psychology; Health Resources; Health services; Health Services Administration - statistics & numerical data; Health services utilization; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Infectious Diseases; Intervention; Male; Medical treatment; Medicine; Medicine & Public Health; Methadone; Middle Aged; Models, Statistical; Original Paper; Physicians; Prescription drugs; Probabilistic models; Public Health; Public Health Administration; Registries; British Columbia; HIV care; Health administrative data; Clustering analysis; Targeted interventions; HIV interventions; Health resource utilization
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-017-1839-x

Increased awareness of the secondary preventive benefits of antiretroviral treatment (ART) has strengthened the desire to optimize health care systems’ response to HIV/AIDS. We identified clusters of health resource utilization (HRU) among people living with HIV (PLHIV) to inform targeted interventions aimed to optimize the cascade of HIV care. Using linked population-level health databases in British Columbia, Canada, we selected two analytic samples of PLHIV with 3 years of follow-up between 2006–2011 that were classified as intermittently retained in care or intermittently engaged in ART, and executed a probabilistic model-based clustering analysis for each sample with 5 and 9 quarterly HRU variables, respectively. We found clear HRU profile differences among both samples with similar HIV-related care: one featured active involvement in non-HIV care, the other little or no health care interaction following linkage to care. Differential reengagement intervention strategies capitalizing on missed opportunities in non-HIV care and further engaging physicians delivering HIV care are needed to optimize the response to the HIV epidemic.