Socioeconomic determinants of virtual care use among people living with HIV in a clinical cohort in Ontario, Canada: A cross-sectional study

Abstract

Background Retention in HIV care is essential for achieving optimal health outcomes and extending life expectancy among people living with HIV. However, socioeconomic challenges frequently hinder consistent engagement in 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 analyzed 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 15 HIV clinics, with data obtained from medical charts, interviews, and linkage to provincial public health lab (PHOL) records for viral load testing. We employed multinomial logistic regression to identify predictors of care mode: virtual, in-person, or a hybrid (virtual and in-person). 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 hybrid care 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), heterosexual 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 (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 (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 hybrid care services. 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..