Health Information for Infected Veterans

Over the last twenty years, HIV has transformed from a terminal disease to a condition with
near normal life expectancy for patients who follow ideal treatment regimens. HIV-infected
individuals still face many challenges and need to be active in self-management of HIV and
other conditions in order to live a healthy life. In order to ensure that this population of
HIV-infected individuals actively self-manages the condition, personal health records (PHRs)
should be used more often. PHRs may simplify disease self-management, improve health
outcomes, and reduce unnecessary health care use.

The VA has one of the nation's largest PHR systems - My HealtheVet (MHV). MHV includes
features that can help patient's self-manage the disease (e.g., prescription refill, viewing
lab results view, secure messaging). While there has been recognition that MHV holds promise
as a self-management tool, there has not yet been an examination of use of MHV features and
the relationship to health outcomes in any chronic disease group, let alone in HIV-infected
Veterans.

The objective of this project is to evaluate MHV use by HIV-infected Veterans and providers,
by completing three aims/steps.

Aim/Step 1: Describe the relationship between use of MHV tools for self-management across
HIV-infected Veterans and determine the relationship to health outcomes and care processes in
these Veterans through review of medical records.

The investigators will use the VA medical record data, which allows for the study of the
diverse VA patient population with patients from a range of personal backgrounds, geographic
locations, and VA health care networks. HIV infection will be determined by the presence of
two outpatient HIV diagnoses or one inpatient HIV diagnosis. This study will use a
retrospective group of HIV-infected Veterans who used MHV between October 2007- October 2018
to evaluate the relationship between patient HIV care outcomes and MHV tool use. The
investigators will look at data to carefully consider HIV-infected patient health status,
health care received, and activity. The investigators will also look at Quality of Care (QC)
outcomes which include medication adherence, CD4 count, viral load testing and detectable
viral load, appointments, patient cancellations, patient no-shows, emergency department
visits, flu vaccination, and syphilis and lipid testing. This aim/step will allow the
investigators to examine differences in VA patients who have opted to use MHV versus those
who have not opted to use MHV.

Aim/Step 2: Describe how Veterans with HIV use MHV for self-management, and why Veterans
choose to use (or not to use) specific MHV tools; and similarly how and why providers use (or
do not use) MHV.

The investigators will interview Veterans and providers to learn what motivates certain
patients and providers/staff to use MHV in a certain way, or to understand MHV system issues,
as well as attitudes and perceptions that prevent others from using MHV. The investigators
will select patients and providers from six VA medical centers and interview those with
high-, low, or no- MHV use. The investigators will discuss how participants use MHV to manage
HIV and other conditions. The investigators will discuss with Veterans how providers use MHV
as a tool for communication and coordination. With Veterans not using MHV (or minimal use),
the investigators will ask about reasons. The interviews will be audio-recorded.

Aim/Step 3: Incorporate findings from Aims/Steps 1 and 2 to design an intervention that will
be tested by Veterans and providers.

The investigators will compare the data from aims/steps 1 and 2 to develop an intervention
that may improve self-management in Veterans with HIV. The investigators will identify
Veterans and providers from two VA medical centers that will help the investigators test the
intervention through "cognitive walkthroughs." Cognitive walkthroughs are used to test an
intervention that is in the early stages of development. Veterans and providers will be the
first to test if the intervention is acceptable and feasible. Participants will also offer
feedback to the researchers as it relates to problems with using the intervention. The
cognitive walkthroughs will be audio- and video-recorded.

Inclusion Criteria:

- HIV diagnosis (determined by the presence of two outpatient HIV diagnoses or one
inpatient HIV diagnosis from 10/2007 to 10/2018)

Exclusion Criteria:

- Children under the age of 18

- Non-English speakers

- Those considered incompetent (as determined by the presence of an ICD-9/10 code for
dementia or Alzheimer's)