Only 54% of people diagnosed with HIV in the U.S. are engaged in regular medical care, and 66% are virally suppressed. Social determinants of health (SDOH), such as housing instability, food insecurity, etc. can serve as barriers to engagement in care for people with HIV (PWH). PWH who have difficulty attending medical appointments often miss out on screening for social needs and linkage to resources for social needs, exacerbating disparities. Patient portals are secure websites, or web-based applications, that give patients access to their health information from anywhere with a web connection, and are becoming increasingly available. Patients who use portals display fewer no-show appointments and greater satisfaction and engagement in care. Electronic patient portals are a promising tool for reaching PWH who do not regularly attend medical visits because they can be used to interact with patients outside of clinic visits. The goal of this project is to use the electronic patient portal to screen for social needs among PWH.

The aim of this project is to implement and evaluate electronic patient portal-based screening for social needs among people with HIV at University of Chicago Medicine.

Social needs screening will be rolled out via MyChart. We will utilize the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework for evaluation. To assess reach, we will measure the proportion of PWH who complete social needs screening via MyChart. To assess effectiveness, we will measure the number of PWH who receive services for social needs. Adoption will be measured based on the number of social work referrals and the proportion of notes documenting social needs and resources given in response to screening. Implementation will be assessed based on fidelity, feasibility, and acceptability. To assess acceptability to patients and providers, we will survey patients and providers using a brief 8-item survey based on the theoretical framework of acceptability (TFA), which is a theory-informed questionnaire, with good face validity. This questionnaire asks about their affective attitude, burden, ethicality, perceived effectiveness, intervention coherence, self-efficacy, opportunity costs, and general acceptability. Surveys will be self-administered on a tablet in a private space at UCM or remotely using REDCap software. We will allow individuals to provide additional feedback with free-text responses and analyze them using rapid qualitative analysis (i.e., grouping data into summary matrices organized by domain). For maintenance, we will evaluate the rate of social needs screening at one year compared to one month after implementation, as well as changes in social needs over time.

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