How do domains of care differ in importance between HIV-infected patients and their care providers? Implications for risk prevention

Background: This study assesses the level of importance attributed to individual care domains by HIV-infected patients in comparison with HIV care providers. Methods: We used two separate, modified Delphi rounds: one for HIV-infected patients representing 4 U.S. sites; another for HIV care providers across 9 U.S. sites. Both groups rank-ordered two lists of care domains in order of importance: those deemed important to general clinical care (anger, anxiety, depression, fatigue, physical function, and pain), and those relevant to HIV care (alcohol abuse, cognitive function, HIV stigma, HIV/treatment symptoms, medication adherence, positive affect, sexual risk behavior, sexual function, social roles, spirituality/meaning of life, and substance use). Patients discussed rationale for choices in focus groups. Results: 74 providers and 35 patients participated. Among the general care domains, agreement was high. Among HIV care domains, patients ranked spirituality/meaning of life, positive affect, HIV stigma, and social roles, considerably higher than providers, while behavioral domains, such as substance use and medication adherence, ranked lower. Conclusion: Patients may attribute higher importance to broader-context domains as necessary to address as part of routine care, and less importance to behavioral domains. Providers, by contrast, may prioritize domains according to likelihood of addressing successfully during a time-constrained clinic visit, which may result in missed opportunities for meaningful discussion of HIV transmission risk behavior. Patients may benefit from referrals to spiritual, social and mental health resources that may help address broader contextual issues in their lives, which may in turn help to reduce HIV transmission risk behaviors.