Socioeconomic determinants of virtual care use among people living with HIV in a clinical cohort in Ontario, Canada: A cross-sectional study
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Background
Engagement in HIV care significantly improves health outcomes and life expectancy. However, socioeconomic challenges often impeder consistent care. Virtual care offers a potential solution by enhancing timely access to HIV services and addressing these barriers.
Objectives
We aimed to examine the association between socioeconomic factors and the use of virtual care among people living with HIV (PLHIV) in a clinical cohort in Ontario, Canada.
Methods
We analysed 2022 data from the Ontario HIV Treatment Network Cohort Study (OCS), coinciding with the initial rollout of virtual care. The OCS is a multi-site cohort comprising patients from 10 HIV clinics, with data obtained from medical charts, interviews, and linkage to provincial public health lab (PHOL) records for viral load testing. Multinomial logistic regression was used to identify predictors of care mode: virtual, in-person, or a combination of both.
Results
The study included 1,930 participants. Of these, 19% (n = 367) received virtual care, 45.6% (n = 900) received in-person care, and 34.3% (n = 663) accessed both virtual and in-person services. The median participant age was 55 years [Q1; Q3: 45; 62], and 78% (n = 1,131) identified as men who have sex with men (MSM).
Compared to Toronto residents, individuals living in Southwestern Ontario had higher odds of using virtual care (adjusted OR (AOR) 1.67, 95% CI: 1.13, 2.47). Conversely, females (AOR = 0.59; 95% CI: 0.40, 0.88), non-MSM men (AOR = 0.64; 95% CI: 0.45, 0.92), residents of Eastern Ontario (AOR = 0.42; 95% CI: 0.26, 0.68), individuals with a high school education compared to those with a university degree (AOR = 0.67; 95% CI: 0.46, 0.98), those with an annual gross income of CAD $71,000-90,000 (AOR = 0.59; 95% CI: 0.38, 0.91), and individuals diagnosed with HIV within the last 10 years compared to those diagnosed more than 10 years ago (AOR = 0.59; 95% CI: 0.39, 0.91) were less likely to use virtual care. Participants experiencing any level of depression were more likely to use both virtual and in-person care options.
Conclusion
Virtual care was introduced during the COVID-19 pandemic to enhance healthcare access in Ontario. Its adoption varied based on socioeconomic and health-related factors in the OCS cohort. Ongoing research is needed to assess these patterns beyond the pandemic context..
