Using Dynamic Causal Bayesian Networks to Assess the Role of Patient-Centered Care and Individual-Level Barriers on Viral Suppression Changes Among a Cohort of People with HIV.

To assess the impact of changes in barriers to HIV viral suppression and the moderating role of patient-provider relationships, we conducted a retrospective cohort study using dynamic causal Bayesian network analyses on the first two available needs assessments between May 2020 and December 2022 for clients of the Miami-Dade County Ryan White Program (RWP) Part A Program. A cohort of 1539 individuals was formed using data from the RWP medical case management dataset. These records were merged with summary patient-centered care measures of their provider that were obtained from an earlier survey of clients in the program. Of the 1539 individuals in the longitudinal cohort, 86.2% were virally suppressed at time point 1 and 87.5% at time point 2. At time point 2, 144 (9.4%) were newly suppressed, and 124 (8.1%) were newly non-suppressed. Of the modifiable factors assessed, drug use and tobacco use significantly predicted a low probability of viral load suppression, while provider rating and provider's Health Care Relationship Trust Score significantly predicted a high probability of viral load suppression, although the associations with drug use and tobacco use were stronger than those with any provider variables. Results highlight the need for interventions promoting strong patient-provider relationships and targeting reductions in tobacco and illegal drug use with priorities based on the prevalence of tobacco and illegal drug use within specific RWP client populations.