A Topic Modeling Analysis of Stigma Dimensions, Social, and Related Behavioral Circumstances in Clinical Notes Among Patients with HIV

Objective: To characterize stigma dimensions, social, and related behavioral circumstances in people living with HIV(PLWHs) seeking care, using NLP methods applied to a large collection of EHR clinical notes from a large integrated health system in the southeast United States. Methods: We identified a cohort of PLWHs from the UF Health IDR and performed topic modeling analysis using Latent Dirichlet Allocation to uncover stigma-related dimensions and related social and behavioral contexts. Domain experts created a seed list of HIV-related stigma keywords, then applied a snowball strategy to review notes for additional terms until saturation was reached iteratively. To identify more target topics, we tested three keyword-based filtering strategies. The detected topics were evaluated using three widely used metrics and manually reviewed by specialists. In addition, we conducted word frequency analysis and topic variation analysis among subgroups to examine differences across age and sex-specific demographics. Results: We identified 9140 PLWHs at UF Health and collected 2.9 million clinical notes. Through the iterative keyword approach, we generated a list of 91 keywords associated with HIV-related stigma. Topic modeling on sentences containing at least one keyword uncovered a wide range of topic themes, such as "Mental Health Concern, Stigma", "Treatment Refusal, Isolation", and "Substance Abuse". Topic variation analysis across age subgroups revealed substantial differences. Conclusion: Extracting and understanding the HIV-related stigma and associated social and behavioral circumstances from EHR clinical notes enables scalable, time-efficient assessment and overcoming the limitations of traditional questionnaires. Findings from this research provide actionable insights to inform patient care and interventions to improve HIV-care outcomes.