Using Causal Bayesian Networks to Assess the Role of Patient-Centered Care and Psychosocial Factors on Durable HIV Viral Suppression

Mary Jo Trepka; Zhenghua Gong; Melissa K Ward; Kristopher P Fennie; Diana M Sheehan; Michele Jean-Gilles; Jessie Devieux; Gladys E Ibañez; Tendai Gwanzura; Ekpereka S Nawfal; Aaliyah Gray; Mary Catherine Beach; Robert Ladner; Changwon Yoo

doi:10.1007/s10461-024-04310-5

Using Causal Bayesian Networks to Assess the Role of Patient-Centered Care and Psychosocial Factors on Durable HIV Viral Suppression

AIDS Behav. 2024 Apr 4. doi: 10.1007/s10461-024-04310-5. Online ahead of print.

Authors

Mary Jo Trepka^{1

2}, Zhenghua Gong³, Melissa K Ward^{4

5}, Kristopher P Fennie⁶, Diana M Sheehan^{4

5}, Michele Jean-Gilles⁷, Jessie Devieux⁷, Gladys E Ibañez⁴, Tendai Gwanzura⁴, Ekpereka S Nawfal⁴, Aaliyah Gray⁴, Mary Catherine Beach⁸, Robert Ladner⁹, Changwon Yoo³

Affiliations

¹ Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA. trepkam@fiu.edu.
² Research Center for Minority Institutions, Florida International University, Miami, FL, USA. trepkam@fiu.edu.
³ Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
⁴ Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, University Park, AHC 5, 11200 SW 8th Street, Miami, FL, 33199, USA.
⁵ Research Center for Minority Institutions, Florida International University, Miami, FL, USA.
⁶ Division of Natural Sciences, New College of Florida, Sarasota, FL, USA.
⁷ Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
⁸ Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.
⁹ Behavioral Science Research Corporation, Coral Gables, FL, USA.

PMID: 38573473
DOI: 10.1007/s10461-024-04310-5

Abstract
in English, Spanish

We assessed the role of patient-centered care on durable viral suppression (i.e., all viral load test results < 200 copies per ml during 2019) by conducting a retrospective cohort study of clients medically case managed by the Miami-Dade County Ryan White Program (RWP). Summary measures of patient-centered care practices of RWP-affiliated providers were obtained from a survey of 1352 clients. Bayesian network models analyzed the complex relationship between psychosocial and patient-centered care factors. Of 5037 clients, 4135 (82.1%) had durable viral suppression. Household income was the factor most strongly associated with durable viral suppression. Further, mean healthcare relationship score and mean "provider knows patient as a person" score were both associated with durable viral suppression. Healthcare relationship score moderated the association between low household income and lack of durable viral suppression. Although patient-centered care supports patient HIV care success, wrap around support is also needed for people with unmet psychosocial needs.

Evaluamos el rol de la atención centrada en el paciente en la supresión viral duradera (es decir, todos los resultados de las pruebas de carga viral < 200 copias por ml durante 2019) mediante la realización de un estudio de cohorte retrospectivo de clientes manejados médicamente por el Programa Ryan White del condado de Miami-Dade (RWP). Se obtuvieron medidas resumidas de las prácticas de atención centradas en el paciente de los proveedores afiliados a RWP usando una encuesta de 1352 clientes. Los modelos de redes bayesianos analizaron la relación compleja entre los factores psicosociales y de atención centrada en el paciente. De 5037 clientes, 4135 (82,1%) tenían una supresión viral duradera. Los ingresos del hogar fueron el factor asociado con la supresión viral duradera más fuerte. Además, la puntuación promedia de la relación con proveedores de atención médica y la puntuación promedia de "el proveedor conoce al paciente como persona" fueron asociados con una supresión viral duradera. La puntuación de la relación con proveedores de atención médica moderó la asociación entre los ingresos bajos del hogar y la falta de supresión viral duradera. Aunque la atención centrada en el paciente apoya el éxito de la atención médica del VIH, también se necesita un apoyo integral para las personas con necesidades psicosociales insatisfechas.

Keywords: Causal Bayesian networks; HIV viral suppression; Patient-centered care; Patient–provider relationships; Social determinants of health.

Abstract in English, Spanish

Grants and funding

Abstract
in English, Spanish