{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T19:15:07Z","timestamp":1771528507978,"version":"3.50.1"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Retention in HIV care is essential for achieving optimal health outcomes and extending life expectancy among people living with HIV. However, socioeconomic challenges frequently hinder consistent engagement in care. Virtual care offers a potential solution by enhancing timely access to HIV services and addressing these barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to examine the association between socioeconomic factors and the use of virtual care among people living with HIV (PLHIV) in a clinical cohort in Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 2022 data from the Ontario HIV Treatment Network Cohort Study (OCS), coinciding with the initial rollout of virtual care. The OCS is a multi-site cohort comprising patients from 15 HIV clinics, with data obtained from medical charts, interviews, and linkage to provincial public health lab (PHOL) records for viral load testing. We employed multinomial logistic regression to identify predictors of care mode: virtual, in-person, or a hybrid (virtual and in-person).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study included 1,930 participants. Of these, 19% (n\u2009=\u2009367) received virtual care, 45.6% (n\u2009=\u2009900) received in-person care, and 34.3% (n\u2009=\u2009663) accessed hybrid care services. The median participant age was 55 years [Q1; Q3: 45; 62], and 78% (n\u2009=\u20091,131) identified as men who have sex with men (MSM). Compared to Toronto residents, individuals living in Southwestern Ontario had higher odds of using virtual care (adjusted OR (AOR) 1.67, 95% CI: 1.13, 2.47). Conversely, females (AOR\u2009=\u20090.59; 95% CI: 0.40, 0.88), heterosexual men (AOR\u2009=\u20090.64; 95% CI: 0.45, 0.92), residents of Eastern Ontario (AOR\u2009=\u20090.42; 95% CI: 0.26, 0.68), individuals with a high school education (AOR\u2009=\u20090.67; 95% CI: 0.46, 0.98), those with an annual gross income of CAD $71,000\u201390,000 (AOR\u2009=\u20090.59; 95% CI: 0.38, 0.91), and individuals diagnosed with HIV within the last 10 years (AOR\u2009=\u20090.59; 95% CI: 0.39, 0.91) were less likely to use virtual care. Participants experiencing any level of depression were more likely to use hybrid care services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Virtual care was introduced during the COVID-19 pandemic to enhance healthcare access in Ontario. Its adoption varied based on socioeconomic and health-related factors in the OCS cohort. Ongoing research is needed to assess these patterns beyond the pandemic context..<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0326989","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T18:24:00Z","timestamp":1771525440000},"page":"e0326989","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Socioeconomic determinants of virtual care use among people living with HIV in a clinical cohort in Ontario, Canada: A cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0174-1527","authenticated-orcid":true,"given":"Nadia","family":"Rehman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5855-5461","authenticated-orcid":true,"given":"Lawrence","family":"Mbuagbaw","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"Mertz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4618-0839","authenticated-orcid":true,"given":"Giulia M.","family":"Muraca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the Ontario HIV Treatment Network Cohort Study","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"issue":"4","key":"pone.0326989.ref001","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1089\/apc.2022.0225","article-title":"Measures of retention in HIV care: a study within a review","volume":"37","author":"N Rehman","year":"2023","journal-title":"AIDS Patient Care STDS"},{"issue":"9","key":"pone.0326989.ref002","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-034793","article-title":"Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1","volume":"10","author":"L Mbuagbaw","year":"2020","journal-title":"BMJ Open"},{"key":"pone.0326989.ref003","unstructured":"World Health Organization. Retention in HIV programmes: defining the challenges and identifying solutions. Meeting report. 2012. [cited 2022 Jun 2]. Available from: https:\/\/www.who.int\/hiv\/pub\/meetingreports\/retention_programmes\/en\/"},{"issue":"1","key":"pone.0326989.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0210096","article-title":"Trends in HIV care cascade engagement among diagnosed people living with HIV in Ontario, Canada: a retrospective, population-based cohort study","volume":"14","author":"J Wilton","year":"2019","journal-title":"PLoS One"},{"issue":"10","key":"pone.0326989.ref005","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1177\/0956462416683626","article-title":"Engagement in and continuity of HIV care among African and Caribbean Black women living with HIV in Ontario, Canada","volume":"28","author":"CH Logie","year":"2017","journal-title":"Int J STD AIDS"},{"key":"pone.0326989.ref006","unstructured":"Ontario HIV Epidemiology and Surveillance Initiative (OHESI). HIV Care Cascade in Ontario: Linkage to Care, In Care, On Antiretroviral Treatment, and Virally Suppressed, 2020.Toronto, ON: OHESI. 2022.Ontario HIV Epidemiology and Surveillance Initiative (OHESI). HIV Care Cascade in Ontario: Linkage to Care, In Care, On Antiretroviral Treatment, and Virally Suppressed, 2020. Toronto, ON: OHESI; 2022. Available from: https:\/\/www.ohesi.ca\/wp-content\/uploads\/2022\/10\/HIV-Care-Cascade-2020-final-1.pdf"},{"key":"pone.0326989.ref007","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1080\/25787489.2020.1763711","article-title":"Examining the association between stress and antiretroviral therapy adherence among women living with HIV in Toronto, Ontario","volume":"21","author":"AC Benoit","year":"2020","journal-title":"HIV Res Clin Pract"},{"issue":"7","key":"pone.0326989.ref008","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1080\/09540121.2016.1271389","article-title":"Social determinants of health and retention in HIV care in a clinical cohort in Ontario, Canada","volume":"29","author":"B Rachlis","year":"2017","journal-title":"AIDS Care"},{"issue":"7","key":"pone.0326989.ref009","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofab330","article-title":"Social determinants of health and care outcomes among people with HIV in the United States","volume":"8","author":"TW Menza","year":"2021","journal-title":"Open Forum Infect Dis"},{"issue":"5","key":"pone.0326989.ref010","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1093\/cid\/ciu357","article-title":"Enhanced personal contact with HIV patients improves retention in primary care: a randomized trial in 6 US HIV clinics","volume":"59","author":"LI Gardner","year":"2014","journal-title":"Clinical Infectious Diseases"},{"issue":"47","key":"pone.0326989.ref011","first-page":"1113","article-title":"Vital Signs: HIV diagnosis, care, and treatment among persons living with HIV--United States, 2011","volume":"63","author":"H Bradley","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0326989.ref012","unstructured":"Government of Canada. Pan-Canadian virtual care priorities in response to COVID-19. 2021. [cited 2024 Jun 5]. Available from: https:\/\/www.canada.ca\/en\/health-canada\/corporate\/transparency\/health-agreements\/bilateral-agreement-pan-canadian-virtual-care-priorities-covid-19.htm"},{"issue":"2","key":"pone.0326989.ref013","doi-asserted-by":"crossref","DOI":"10.2196\/publichealth.6896","article-title":"Physician\u2019s perceptions of telemedicine in HIV care provision: a cross-sectional web-based survey","volume":"3","author":"K Anderson","year":"2017","journal-title":"JMIR Public Health Surveill"},{"issue":"5","key":"pone.0326989.ref014","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.7374","article-title":"Virtual visits and patient-centered care: results of a patient survey and observational study","volume":"19","author":"KM McGrail","year":"2017","journal-title":"J Med Internet Res"},{"issue":"5","key":"pone.0326989.ref015","article-title":"Association between virtual visits and health outcomes of people living with HIV: A cross-sectional study","volume":"20","author":"Ontario HIV Treatment Network Cohort Study","year":"2025","journal-title":"PLoS One"},{"issue":"3","key":"pone.0326989.ref016","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/QAD.0000000000003119","article-title":"Telemedicine and visit completion among people with HIV during the coronavirus disease 2019 pandemic compared with prepandemic","volume":"36","author":"WG El-Nahal","year":"2022","journal-title":"AIDS"},{"key":"pone.0326989.ref017","unstructured":"Government of Canada. Pan-Canadian virtual care priorities in response to COVID-19. 2021. [cited 2023 Apr 21]. Available from: www.canada.ca\/en\/health-canada\/corporate\/transparency\/health-agreements\/bilateral-agreement-pan-canadian-virtual-care-priorities-covid-19.htm"},{"issue":"4","key":"pone.0326989.ref018","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s10461-018-2320-1","article-title":"HIV standard of care for ART adherence and retention in care among hiv medical care providers across four CNICS Clinics in the US","volume":"23","author":"S Shaw","year":"2019","journal-title":"AIDS Behav"},{"key":"pone.0326989.ref019","unstructured":"Realize. Fostering positive change for people living with HIV and other episodic disabilities. 2023. [cited 23 June 2023]. Available from: http:\/\/forum.realizecanada.org\/about-us\/"},{"issue":"1","key":"pone.0326989.ref020","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s40900-022-00390-6","article-title":"Building capacity in quantitative research and data storytelling to enhance knowledge translation: a training curriculum for peer researchers","volume":"8","author":"JM Lo Hog Tian","year":"2022","journal-title":"Res Involv Engagem"},{"issue":"8","key":"pone.0326989.ref021","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.2105\/AJPH.2007.113571","article-title":"The power and the promise: working with communities to analyze data, interpret findings, and get to outcomes","volume":"98","author":"SB Cashman","year":"2008","journal-title":"Am J Public Health"},{"key":"pone.0326989.ref022","unstructured":"The OHTN Cohort Study. 2023. [cited Jan 15]. Available from: https:\/\/ohtncohortstudy.ca\/"},{"issue":"2","key":"pone.0326989.ref023","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1093\/ije\/dyr230","article-title":"Cohort profile: the Ontario HIV Treatment Network Cohort Study (OCS)","volume":"42","author":"SB Rourke","year":"2013","journal-title":"Int J Epidemiol"},{"issue":"2","key":"pone.0326989.ref024","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1093\/ije\/dyr230","article-title":"Cohort profile: the Ontario HIV Treatment Network Cohort Study (OCS)","volume":"42","author":"SB Rourke","year":"2013","journal-title":"Int J Epidemiol"},{"key":"pone.0326989.ref025","unstructured":"Ontario HIV Treatment Network. OCS (OHTN Cohort Study): Research Policies. [cited 2023 Jun 5]. Available from: https:\/\/ohtncohortstudy.ca\/wp-content\/uploads\/2022\/12\/OCS-Research-Policies_6-Oct-2022_Clean.pdf"},{"issue":"2","key":"pone.0326989.ref026","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1177\/2325957414557263","article-title":"Self-report measures in the assessment of antiretroviral medication adherence: comparison with medication possession ratio and HIV viral load","volume":"14","author":"L Kabore","year":"2015","journal-title":"J Int Assoc Provid AIDS Care"},{"issue":"9","key":"pone.0326989.ref027","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1111\/j.1468-1293.2012.01012.x","article-title":"Factors associated with a strictly undetectable viral load in HIV-1-infected patients","volume":"13","author":"G Martin-Blondel","year":"2012","journal-title":"HIV Med"},{"issue":"16","key":"pone.0326989.ref028","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1001\/archinte.158.16.1789","article-title":"The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test","volume":"158","author":"K Bush","year":"1998","journal-title":"Arch Intern Med"},{"issue":"1","key":"pone.0326989.ref029","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0165-0327(03)00198-8","article-title":"Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9)","volume":"81","author":"B L\u00f6we","year":"2004","journal-title":"J Affect Disord"},{"issue":"2","key":"pone.0326989.ref030","doi-asserted-by":"crossref","first-page":"169","DOI":"10.14283\/jpad.2020.50","article-title":"Mental Component Score (MCS) from Health-Related Quality of Life Predicts Incidence of Dementia in U.S. Males","volume":"8","author":"X Ding","year":"2021","journal-title":"J Prev Alzheimers Dis"},{"issue":"5","key":"pone.0326989.ref031","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1590\/1516-4446-2019-0753","article-title":"N-acetylcysteine as an adjunctive treatment for smoking cessation: a randomized clinical trial","volume":"42","author":"RCBR Machado","year":"2020","journal-title":"Braz J Psychiatry"},{"issue":"6","key":"pone.0326989.ref032","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1007\/s40615-020-00736-4","article-title":"HIV-related stigma among black mothers in two North American and One African Cities","volume":"7","author":"J Etowa","year":"2020","journal-title":"J Racial Ethn Health Disparities"},{"issue":"3","key":"pone.0326989.ref033","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1081\/QEN-120001878","article-title":"Model-dependent variance inflation factor cutoff values","volume":"14","author":"TA Craney","year":"2002","journal-title":"Qual Eng"},{"issue":"2","key":"pone.0326989.ref034","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1037\/0033-2909.95.2.334","article-title":"Outliers and influential data points in regression analysis","volume":"95","author":"JP Stevens","year":"1984","journal-title":"Psychol Bull"},{"issue":"5","key":"pone.0326989.ref035","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1023\/A:1012552211996","article-title":"Do SF-36 summary component scores accurately summarize subscale scores?","volume":"10","author":"C Taft","year":"2001","journal-title":"Qual Life Res"},{"key":"pone.0326989.ref036","volume-title":"Conditional logit analysis of qualitative choice behavior","author":"D McFadden","year":"1972"},{"key":"pone.0326989.ref037","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.2307\/1910997","article-title":"Specification tests for the multinomial logit model","author":"J Hausman","year":"1984","journal-title":"Econometrica: J Econ Soc"},{"key":"pone.0326989.ref038","volume-title":"Regression models for categorical dependent variables using Stata","author":"JS Long","year":"2006"},{"issue":"6","key":"pone.0326989.ref039","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1097\/00006199-200211000-00009","article-title":"Multinomial logistic regression","volume":"51","author":"C Kwak","year":"2002","journal-title":"Nurs Res"},{"key":"pone.0326989.ref040","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.jclinepi.2022.08.016","article-title":"Handling missing data in clinical research","volume":"151","author":"MW Heymans","year":"2022","journal-title":"J Clin Epidemiol"},{"key":"pone.0326989.ref041","volume-title":"Iris. Applied missing data analysis with SPSS and (R) Studio","author":"ME Heymans","year":"2019"},{"issue":"1","key":"pone.0326989.ref042","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.3264","article-title":"Virtual intervention to support self-management of antiretroviral therapy among people living with HIV","volume":"17","author":"J C\u00f4t\u00e9","year":"2015","journal-title":"J Med Internet Res"},{"issue":"8","key":"pone.0326989.ref043","doi-asserted-by":"crossref","first-page":"2686","DOI":"10.1007\/s10461-022-03607-7","article-title":"Age and racial disparities in telehealth use among people with HIV during the COVID-19 pandemic","volume":"26","author":"EE Friedman","year":"2022","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0326989.ref044","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1186\/s12913-022-08010-5","article-title":"Challenges and opportunities of telehealth digital equity to manage HIV and comorbidities for older persons living with HIV in New York State","volume":"22","author":"A Baim-Lance","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"pone.0326989.ref045","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1093\/jamia\/ocaa284","article-title":"Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization","volume":"28","author":"JM Ferguson","year":"2021","journal-title":"J Am Med Inform Assoc"},{"key":"pone.0326989.ref046","unstructured":"Wikipedia. Timeline of the COVID-19 pandemic in Ontario. 2022. [cited 2022 Sep 24]. Available from: https:\/\/en.wikipedia.org\/wiki\/Timeline_of_the_COVID-pandemic_in_Ontario"},{"key":"pone.0326989.ref047","unstructured":"Government of Ontario. Virtual Care 1: Comprehensive and Limited Virtual Care Services. 2022. [cited 2023 Aug 24]. Available from: https:\/\/www.ontario.ca\/document\/education-and-prevention-committee-billing-briefs\/virtual-care-1-comprehensive-and-limited#section-2"},{"key":"pone.0326989.ref048","unstructured":"Government of Ontario. OHIP Info Bulletins. 2022.https:\/\/www.ontario.ca\/documents\/ohipbulletin-220901-implementationofthenewvirtualcarefundingframework"},{"issue":"4","key":"pone.0326989.ref049","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s10461-018-2320-1","article-title":"HIV Standard of Care for ART Adherence and Retention in Care Among HIV Medical Care Providers Across Four CNICS Clinics in the US","volume":"23","author":"S Shaw","year":"2019","journal-title":"AIDS Behav"},{"key":"pone.0326989.ref050","unstructured":"United Nations. The Sustainable Development Goals Report. 2016. Availalble from: https:\/\/www.un.org\/en\/desa\/sustainable-development-goals-report-2016"},{"issue":"1","key":"pone.0326989.ref051","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1038\/s41746-021-00528-y","article-title":"Telephone, video, equity and access in virtual care","volume":"4","author":"T Thomas-Jacques","year":"2021","journal-title":"NPJ Digit Med"},{"key":"pone.0326989.ref052","unstructured":"Ontario Health. Clinically appropriate use of virtual care in primary care. CD Howe Institute Toronto. 2022. [cited 2023 Nov 15] Available from: https:\/\/www.ontariohealth.ca\/sites\/ontariohealth\/files\/2022-11\/TargetAudienceConceptsStatements.pdf"},{"key":"pone.0326989.ref053","article-title":"Determining Sample Size; How to Calculate Survey Sample Size","volume":"2","author":"H Taherdoost","year":"2017","journal-title":"Int J Econ Manage Syst"},{"issue":"6","key":"pone.0326989.ref054","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1097\/00000542-200312000-00003","article-title":"Principles of successful sample surveys","volume":"99","author":"LF Burmeister","year":"2003","journal-title":"Anesthesiology"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0326989","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T18:24:14Z","timestamp":1771525454000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0326989"}},"subtitle":[],"editor":[{"given":"Jiawen","family":"Deng","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":54,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,19]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0326989","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]}}}