Around 60% of people living with HIV would choose GP care in preference to an HIV clinic, a UK study has found.

The researchers carried out a discrete choice experiment in which people living with HIV were asked to choose between an appointment with a GP or an HIV clinic. Participants were given a scenario where they had to imagine they were on antiretroviral therapy and had been feeling well for the previous three months, but became unwell on the day of the study. They were given a set of contrasting attributes, supported by evidence, including: skills in managing many medical problems, ability to refer on to other healthcare professionals, accessibility, and continuity.

A total of 1,106 questionnaires were returned and participants completed 97.6% of responses. More than a third (38%) of respondents were aged 50 or over, 85% were men, 74% white and 69% men who have sex with men. More than 95% were registered with a GP, 87% said that they had disclosed their status to their GP, and 74% said that their GP knew their sexuality.

Participants were divided into two categories based on their responses. Those in class 1 (59%) preferred GP to HIV clinic appointments when all other factors were disregarded (OR 4.39 (95% CI: 3.82-5.10). They valued timely appointments in particular, out of hours services, and were less concerned about how many times they had previously seen an HIV specialist or if they had seen their GP twice or less in the previous year (P > 0.05 in both instances).

They strongly preferred GPs whom they had seen more than twice in the past year OR 2.72 (95% CI: 1.86-3.99) and who had received specialist HIV training OR 3.22 (95% CI: 2.45-4.24).

Participants in this group also preferred HIV consultants of all the  options for an HIV clinic appointment OR 2.98 (95% CI: 2.14-4.14), and appointments where the GP OR 1.96 (95% CI: 1.55-2.48) or HIV professional OR 1.96 (95% CI: 1.49-2.57) had all their clinical information available.

Participants in class 2 (41%) placed greater value on HIV clinic than GP appointments when all other factors were disregarded OR 3.63 (95% CI: 3.20-4.11). They too preferred shorter waiting times for appointments. They were indifferent as to how many times they had seen their GP over the past year, but valued having seen their HIV specialist at least once in the previous year compared with not at all. Although their preferences for GP appointments were low, they had a strong preference for appointments with GPs with training in HIV. They also valued their HIV specialist having access to all their clinical information compared with partial information OR 1.59 (95% CI: 1.30-1.95) but not their GP OR 1.07 (95% CI: 0.84-1.36).

A multivariable analysis suggested that those who were in perfect health OR 1.56 (95% CI: 1.16-2.11) and those who had disclosed their status to their GP OR 2.31 (95% CI: 1.45-3.67) were more likely to be in class 1 than class 2.

Like other patients with long-term conditions, people living with HIV value continuity of care, timely access to a GP and healthcare professionals having up to date information about their care.

Dr Richard Ma