Advance directives among people living with HIV: room for improvement

Abstract

While HIV has become a largely chronic disease, age-associated comorbidities are prevalent in people living with HIV (PLWH). Therefore, PLWH are appropriate for advance care planning (ACP) and advance directives (ADs) completion. We sought to characterize AD completion among outpatient PLWH. We conducted a retrospective chart review of PLWH who receive their routine care at the University of Wisconsin HIV clinic. Data were extracted from the electronic health record. Variables were entered into a stepwise multivariate logistic regression model to assess which factors were independently associated with AD completion. Five hundred and eighty eight charts were reviewed. Eighty-one percent of subjects were male and 72% were white; mean age was 46.8 years. ADs were completed by 134 subjects and 6.7% of those were completed at the HIV clinic. In the final multivariate model, those who had completed an AD were more likely to be older than age 45; ever been diagnosed with AIDS; have cardiovascular disease, neurologic disorder, chronic kidney disease, or malignancy. In this study, a small percentage of patients had documented ADs, with only a small proportion completed in the HIV clinic. The HIV clinic is an underutilized resource to offer ACP. Interventions are needed to provide the necessary ACP resources for PLWH.

Keywords:

• HIV/AIDS
• outpatient clinic
• patient care
• advance directives
• advance care planning

Acknowledgments

The authors wish to thank Dr. Toby Campbell for his expertise and support regarding the inception of this project. In addition, we wish to acknowledge Helena Tsotsis for help assistance with data management and collection. We would also like to thank the UW-based Honoring Choices Wisconsin team who provided invaluable input into the design of this study.

Additional information

Funding

This study was supported by the Division of Infectious Diseases at the UW in Madison, WI.