PIN87 PATIENT ENGAGEMENT IN HIV CARE MANAGEMENT: BEHAVIOR ECONOMICS OF ART ADHERENCE AND ESTABLISHING CARE VISITS

Abstract

Despite available potent and efficacious anti-retroviral therapy(ART), optimal treatment outcomes remain challenging with HIV patients and cannot be achieved without high levels of patient engagement. We explore whether patient implicit decision-making in valuing ongoing care can be elicited through observable engaged behavior—ART adherence and clinic appointments. Electronic health records (EHR) and pharmacy dispensing data within a single health care system were linked at individual patient levels. The relationship between adherence behavior (Proportion of Days Covered [PDC]) and “no show” office visit rates was examined as a proxy for patient valuation of engaged behavior in HIV management. Adults (18+ years) with newly established HIV care and initiating on once-daily ART between January 2009 and October 2019 were included. PDC was calculated using ART dispensed dates and days of supplies during their initiated regimen. Appointment status was categorized as completed, canceled, and “no show”. Patient demographics and regimen characteristics (e.g., copay, single- and multi-tablet regimen) were evaluated as covariates. GEE regression model was fitted with PDC as the dependent variable. Analyses were conducted using SAS 9.4. 53 patients were included in analysis-- 44 (83.0%) male; mean age=35.2 years at the time of establishing HIV care. 45 (84.9%) and 8 (15.1%) initiated single and multi-tablet regimens, respectively. Mean PDC for first-line therapy was 0.718; mean individual “no show” rate was 0.144, and 22 (41.5%) never had a “no show” event. PDC was lower with a higher “no show” rate (r= -0.380; p=0.005) and higher with older age (r=0.276; p=0.045). In the GEE regression model, having any “no show” event and age were predictors for PDC (beta_hat= -0.153 and 0.0056; p<0.05, respectively). Highly correlated patterns between ART adherence and appointment status may reflect an implicit decision-making process in the valuation of ongoing HIV care, as "No show” behavior predicts adherence behavior.