Suitability and Acceptability of Decentralised Care for People Living with HIV

HIV management is evolving, with improved long-term survival and patient health. However, the model of care for people living with HIV (PLWHIV) in Ireland has remained unchanged, with care focused in tertiary sites in urban centres. We explored the acceptability of decentralised HIV care at local hospitals, community healthcare settings, or with primary care providers (PCP), and the acceptability of receiving antiretroviral therapy (ART) locally. HIV attendees at two tertiary referral centres were invited to complete a questionnaire recording demographics, transit time to clinic, engagement with PCP, satisfaction with current model of care and acceptability of alternative models on a Likert scale and provide written qualitative feedback. The relationship between acceptance of new models of care and sociodemographic factors were investigated. N = 511 (71% male) PLWHIV at two tertiary HIV centres participated. The median time spent traveling to and from clinic was 1 h 50 min. While the current model of care was convenient to the majority, decentralised care models were also acceptable to most participants. Longer travel time was associated with increased acceptance of care locally (β=-0.015, p < 0.001), while male sex was associated with acceptance of community-based care (β=-1.11, p = 0.007). Care in the community and receipt of ART locally was more acceptable to younger patients. Concerns regarding stigma and lack of local expertise were cited as barriers to changing the current care model. We identify a cohort of PLWHIV for whom an alternative model of care is preferable, and supports the development of a hybrid HIV care model in Ireland.