Disparities in HIV positive men of color HIV positive men of - - PowerPoint PPT Presentation

Amenability of HIV-positive African American Men to Shared Medical Appointments for Primary Care

Colin Gershon, N.P., M.P.H.; Matthew Siegel, B.S.; Matthew Masankay, B.S.; Michael Arnold, Ph.D., Malcolm John, M.D., M.P.H. Division of Infectious Disease, Department of Medicine University of California, San Francisco

Disparities in HIV positive men of color

• HIV positive men of color:
• Constitute a disproportionate % of individuals living with HIV
• Experience poorer health outcomes after HIV diagnosis
• This disparity is due to a variety of factors including:
• Low adherence to anti-retroviral therapy
• Mistrust of the medical system
• Higher rates of missed clinic visits
• Provider bias

How a Shared Medical Appointment (SMA) Model can address HIV health disparities

• The shared medical appointment (SMA) is a model in which medical care is provided

to two or more patients concurrently followed by short, private sessions of history- taking and physical examination.

• Evidence suggests SMAs may improve:
• Patient trust in the medical system
• Medical appointment attendance
• Patient satisfaction with medical care
• Biological outcomes
• Cost of care
• Provider satisfaction
• Within HIV+ African American population, SMA is expected to:
• Improve clinic visit attendance
• Improve patient satisfaction with care
• Improve patient health literacy through increased interactions with provider

and other specialists

• Build support around health issues which may help address isolation, HIV

stigma and health care fatigue

• Develop skill-set to deal with issues common to patient group…and more

SMA Amenability Study Parameters

• Study Aims:
• percentage of HIV+ AA men at 360 amenable to SMA participation (groups
• f 4 patients)
• socioeconomic, demographic ,or other factors potentially associated with

willingness to participate in an SMA

• programmatic design factors potentially associated with willingness to

participate in an SMA

• Hypotheses:
• majority of participants would be amenable to SMA participation at 360
• no significant association between willingness to participate and

socioeconomic or demographic factors

• association between programmatic factors and willingness to participate

Demographics

Table 1. Demographics

Amenability to Participate in SMA

Figure 1. How strongly do you agree with the following statement: “I would consider participating in [an SMA at this clinic]” No demographic , socioeconomic , or care variables were associated with willingness to participate at α = 0.05, except for patient satisfaction with their medical care. A positive trend was seen between this variable and amenability with P=.04.

Programmatic Factors Associated with Willingness to Participate

Table 2. Among those willing to participate, what programmatic factors are most desirable?

Conclusions

• Over 2/3 of participants were amenable to a SMA
• No demographic or socioeconomic variables were associated with willingness

to participate

• Significant trend between patient satisfaction with current care and willingness

to participate

• Programmatic factors more associated with willingness to participate included:
• confidentiality
• private time with provider
• group led by primary provider
• familiarity with other patients
• length of appointment
• The SMA model may be a feasible clinical intervention at 360, and at other HIV

clinics in urban environments.

• Next Steps – 6 month pilot with Mallory Johnson at Center for AIDS Prevention

Studies