1017 - Haves vs. Have-Nots in Healthcare Communication: Examining the Paradox Where PLHIV Who Need Quality Discussions with their Providers the Most, Access it the Least

Background: Quality communication between patients & HCPs is important to help to identify/address treatment gaps. Who initiates this communication may vary, but impact of good quality communication as a marker of successful care has not been fully explored in PLHIV. We investigated whether perceived comfort discussing salient issues with HCPs differed between PLHIV with vs without specific treatment challenges.

Methods: We analyzed self-reported data for 520 PLHIV from the 2019 Positive Perspectives study from Canada and USA. Engagement in care (low, moderate, high), was modified from the Observing Patient Involvement scale. Using Chi-squared tests, we compared communication barriers among those uncomfortable discussing with their HCP (p< .05).

Results: Mean age was 39.6 years. Perceived comfort discussing salient issues with HCPs was significantly lower among PLHIV with than without the specified challenges: discussing side effects (those experiencing side effects=50.4%[135/268] vs without=60.7%[153/252], p=.018); discussing privacy concerns (those hiding medications=41.3%[138/334] vs not hiding =66.7%[124/186], p< .001); discussing adherence challenges (those with suboptimal =42.4%[78/184] vs optimal adherence=57.7%[194/336], p=.001); discussing concerns about HIV illnesses (those without viral suppression=43.1%[90/209] vs virally suppressed=64.6%[201/311], p< .001); and discussing impact of HIV on their life (45.4%[100/220] vs 62.7%[188/300] among those reporting vs not reporting that HIV negatively impacts their life, respectively, p< .001). Among those uncomfortable discussing HCP/clinic-related barriers (eg, no time during visits, worried HCP might perceive them as “difficult”) and limited self-efficacy were particularly more prevalent among those with vs without specific challenges (Figure 2). Pooled analysis showed that optimal self-rated health was 33.9%[42/124]; 52.1%[112/215]; and 68.5%[124/181] among those with low, moderate, & high engagement (p< .001, Figure 3).Figure 1
Figure 2
Figure 3


Conclusion: Individuals uncomfortable discussing issues with their HCP reported greater treatment challenges. Proactive HCP-driven high-quality communications with all patients is necessary to help address these concerns.