Heterogeneity of provider preferences for HIV Care Coordination Program features: latent class analysis of a discrete choice experiment

Abstract

The PROMISE study assessed revisions designed to facilitate implementation of an HIV care coordination program (CCP) addressing gaps in care and treatment engagement among people living with HIV in New York City (NYC). Through latent class analysis (LCA) of a discrete choice experiment (DCE), we explored heterogeneity of provider preferences regarding CCP features. From January-March 2020, 152 NYC CCP providers completed a DCE with 3–4 levels on each of 4 program attributes: 1) Help with Adherence to Antiretroviral Therapy (ART), 2) Help with Primary Care Appointments, 3) Help with Issues Other than Primary Care, and 4) Where Program Visits Happen. We used LCA to assess patterns of preference, and choice simulation to estimate providers’ endorsement of hypothetical CCPs. LCA identified three subgroups. The two larger subgroups (n = 133) endorsed more intensive individual program features, including directly observed therapy, home visits, and appointment reminders with accompaniment of clients to their appointments. The smallest subgroup (n = 19) endorsed medication reminders only, appointment reminders without accompaniment, and meeting at the program location rather than clients’ homes. Choice simulation analysis affirmed the highest degree of endorsement (62%) for hypothetical programs combining the intensive features described above. Results indicated providers’ preference for intensive program features and also reinforced the need for flexible service delivery options. Provider perspectives on service delivery approaches can inform program adjustments for successful long-term implementation, which in turn can improve patient outcomes.

Keywords:

• Discrete choice experiment
• latent class analysis
• HIV care coordination
• New York City
• adherence

Acknowledgements

The content is the sole responsibility of the authors and does not necessarily reflect the official views of NIH. We would like to acknowledge Sarah Kulkarni for her help with logistics and securing funding for the study; Sarah Kozlowski for her help with logistics and recruitment; Kate Taylor for her contribution to the conceptualization and drafting of the DCE; and Tye Seabrook, Grace Herndon, Scarlett Macías, Graham Harriman and the PROMISE qualitative research team [Rachel Schenkel, Thamara Tapia, Miguel Hernandez and Honoria Guarino], for their contributions to the larger project. We would also like to acknowledge the PROMISE Study Advisory Board members for their contributions to the study (in alphabetical order by last name): Mohammed Aldhuraibi for ACACIA Network, Lori Hurley for the STAR Program at SUNY Downstate Medical Center, Tiffany Jules for Services for the UnderServed, Inc., Genesis Luciano for AIDS Center of Queens County, Cyndi Morales for the Council on Adoptable Children, and Vanessa Pizarro for COMPASS.

Authors’ contributions

DN and MI conceptualized the study. ABL conducted formative work. ABL, DN, MI, and RZ collaborated on the design of the data collection tool. CF and RZ performed statistical analyses. CF, MC, and RZ wrote the first draft of the paper. CF, MC, RZ, ABL, MR, JC, GG, ABL, MR, MI, and DN contributed to interpreting the data and to the writing and revising of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institutes of Health (NIH), grant number R01 MH117793 (Project Officer Christopher M Gordon, [email protected]).