Healthcare Acceptability and Delayed Care Among Older People Living with HIV in the All of Us Program

Timely engagement in healthcare is crucial for effective management of HIV, comorbidities, and disease prevention among older people living with HIV (PLHIV). Healthcare acceptability may be especially important for older PLHIV who have experienced long-standing stigma, medical mistrust, and culturally insensitive care. This study examined healthcare acceptability and its association with delayed care among older (≥ 50 years) PLHIV and assessed whether demographic characteristics moderated this relationship. Using data from the All of Us Research Program collected between May 2017 and July 2022, we conducted a cross-sectional analysis of 920 participants across the United States. Descriptive statistics and logistic regression were used to analyze the data. Majority of the sample identified as White (47.4%), gay or lesbian (47.1%), and publicly insured (55.2%). A one-point increase in healthcare acceptability was associated with lower odds of delayed care (aOR=0.762, 95% CI [0.691, 0.838]). Compared to White participants, the association between valuing a provider with a similar background and delayed care was stronger among Black participants, with greater importance of provider similarity associated with lower odds of delayed care (aOR=0.265, 95% CI [0.096, 0.723]). Higher comorbidity was associated with greater odds of delayed care; however, these odds were lower among participants who felt they were always treated with respect (aOR=0.514, 95% CI [0.264, 0.990]). There were no significant interactions observed between healthcare acceptability and demographic characteristics. Healthcare systems should prioritize patient-centered care, an inclusive workforce, and integration of healthcare acceptability measures into quality improvement to enhance timely care and reduce disparities among older PLHIV.