Relationship Between Patient Portal Tool Use and Medication Adherence and Viral Load Among Patients Living with HIV

Background Patient portals play an increasingly critical role in engaging patients in their health care. They have the potential to significantly impact the health of those living with chronic diseases, such as HIV, for whom consistent care engagement is both critical and complex. Objective The primary aim was to examine the longitudinal relationships between individual portal tool use and health-related outcomes in patients living with HIV. Design Retrospective cohort study using electronic health record data to examine the relationship between patient portal tool use and key HIV-specific, health-related outcomes in patients engaged in care in the Veterans Health Administration (VA) through the application of marginal structural models. Participants A national sample of patients living with HIV (PLWH) active in VA care who were registered to use the VA’s patient portal, My Health e Vet (MHV; n = 18,390) between 10/1/2012 and 4/1/2017. Main Measures The MHV tools examined were prescription refill (including prescription refill of an antiretroviral (ART) medication and any medication), secure messaging, view appointments, and view labs. Primary outcomes were viral load test receipt, viral load suppression, and ART medication adherence (measured as proportion of days covered). Key Results The use of prescription refill for any medication or for ART was positively associated with ART adherence. Secure messaging was positively associated with ART adherence but not with viral load test receipt or viral load suppression. The use of view appointments was positively associated with ART adherence and viral load test receipt but not viral load suppression. The use of view labs was positively associated with viral load suppression but not ART adherence or viral load test receipt. Conclusions These findings highlight the valuable role patient portals may play in improving health-related outcomes among PLWH and have implications for patients living with other types of chronic disease.