Background: 

Homelessness and unstable housing (HUH) negatively impact care outcomes for people living with HIV (PLWH). To inform the design of a clinic program for PLWH experiencing HUH, we quantified patient preferences and trade-offs across multiple HIV-service domains using a discrete choice experiment (DCE).

Methods: 

We sequentially sampled PLWH experiencing HUH presenting at an urban HIV clinic with ≥1 missed primary care visit and viremia in the last year to conduct a DCE. Participants chose between 2 hypothetical clinics varying across 5 service attributes: care team “get to know me as a person” versus not; receiving $10, $15, or $20 gift cards for clinic visits; drop-in versus scheduled visits; direct phone communication to care team versus front-desk staff; and staying 2 versus 20 blocks from the clinic. We estimated attribute relative utility (ie, preference) using mixed-effects logistic regression and calculated the monetary trade-off of preferred options.

Results: 

Among 65 individuals interviewed, 61% were >40 years old, 45% White, 77% men, 25% heterosexual, 56% lived outdoors/emergency housing, and 44% in temporary housing. Strongest preferences were for patient-centered care team [β = 3.80; 95% confidence interval (CI): 2.57 to 5.02] and drop-in clinic appointments (β = 1.33; 95% CI: 0.85 to 1.80), with a willingness to trade $32.79 (95% CI: 14.75 to 50.81) and $11.45 (95% CI: 2.95 to 19.95) in gift cards/visit, respectively.

Conclusions: 

In this DCE, PLWH experiencing HUH were willing to trade significant financial gain to have a personal relationship with and drop-in access to their care team rather than more resource-intensive services. These findings informed Ward 86's “POP-UP” program for PLWH-HUH and can inform “ending the HIV epidemic” efforts.

中文翻译：

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了解无家可归或住房不稳定患者的HIV护理偏好：一项离散选择实验

背景： 

无家可归和不稳定住房（HUH）对艾滋病毒感染者（PLWH）的护理结果产生负面影响。为了告知经历过HUH的PLWH临床计划的设计，我们使用离散选择实验（DCE）量化了跨多个HIV服务域的患者偏好和权衡。

方法： 

我们对去年在城市HIV诊所中出现过HUH的PLWH进行了抽样，在去年进行一次DCE时，他们错过了≥1次初级保健就诊和病毒血症。参与者选择了5种服务属性不同的2个假设诊所：护理团队“了解我一个人”与否；收到10美元，15美元或20美元的礼品卡用于诊所就诊; 参观与预定访问；与护理团队和前台人员进行直接电话通讯；距离诊所2个街区和20个街区。我们使用混合效应逻辑回归估计属性相对效用（即偏好），并计算了优先选择权的货币权衡。

结果： 

在接受采访的65个人中，有61％为40岁以上的白人，45％的白人，77％的男性，25％的异性恋，56％的人住在户外/紧急住房中，以及44％的临时住房。最优先选择以患者为中心的护理小组[β= 3.80; 95％置信区间（CI）：2.57至5.02]和即时诊所预约（β= 1.33； 95％CI：0.85至1.80），愿意交易$ 32.79（95％CI：14.75至50.81）和$ 11.45（每次访问礼品卡的95％CI：2.95至19.95）。

结论： 

在此DCE中，体验HUH的PLWH愿意交易可观的经济收益，以便与他们的护理团队建立个人关系并可以使用其服务渠道，而不是更耗费资源的服务。这些发现为Ward 86对PLWH-HUH的“ POP-UP”计划提供了信息，并可以为“结束HIV流行”的努力提供信息。