Barriers to Universal Prescribing of Antiretroviral Therapy by HIV Care Providers in the United States, 2013–2014

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Weiser, John ; Brooks, John T. ; Skarbinski, Jacek ; West, Brady T. ; Duke, Christopher C. ; Gremel, Garrett W. ; Beer, Linda
• Description:
  Introduction
  
  HIV treatment guidelines recommend initiating antiretroviral therapy (ART) regardless of CD4 cell (CD4) count, barring contraindications or barriers to treatment. An estimated 6% of persons receiving HIV care in 2013 were not prescribed ART. We examined reasons for this gap in the care continuum.
  
  Methods
  
  During 2013–2014, we surveyed a probability sample of HIV care providers, of whom 1234 returned surveys (64.0% adjusted response rate). We estimated percentages of providers who followed guidelines and their characteristics, and who deferred ART prescribing for any reason.
  
  Results
  
  Barring contraindications, 71.2% of providers initiated ART regardless of CD4 count. Providers less likely to initiate had caseloads ≤20 vs. >200 patients [adjusted prevalence ratios (aPR) 0.69, 95% confidence interval (CI): 0.47 to 1.02, P = 0.03], practiced at non–Ryan White HIV/AIDS Program-funded facilities (aPR 0.85, 95% CI: 0.74 to 0.98, P = 0.02), or reported pharmaceutical assistance programs provided insufficient medication to meet patients’ needs (aPR 0.79, 95% CI: 0.65 to 0.98, P = 0.02). In all, 17.0% never deferred prescribing ART, 69.6% deferred for 1%–10% of patients, and 13.3% deferred for >10%. Among providers who had deferred ART, 59.4% cited patient refusal as a reason in >50% of cases, 31.1% reported adherence concerns because of mental health disorders or substance abuse, and 21.4% reported adherence concerns because of social problems, eg, homelessness, as factors in >50% of cases when deferring ART.
  
  Conclusions
  
  An estimated 29% of HIV care providers had not adopted recommendations to initiate ART regardless of CD4 count, barring contraindications, or barriers to treatment. Low-volume providers and those at non–Ryan White HIV/AIDS Program-funded facilities were less likely to follow this guideline. Among all providers, leading reasons for deferring ART included patient refusal and adherence concerns.
  
  
• Subjects:
  Anti-Retroviral Agents Drug Prescriptions Guideline Adherence Health Personnel Health Services Accessibility HIV Infections Humans Surveys And Questionnaires United States
• Keywords:
  Antiretroviral Initiation HIV Provider Barrier Prescribing
• Source:
  J Acquir Immune Defic Syndr. 74(5):479-487
• Pubmed ID:
  28002186
• Pubmed Central ID:
  PMC5494707
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Volume:
  74
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:28c825bf2dad51f5b16c7ed89fe3d5c5e5286a9efe9fba8218447295723a5322
• Download URL:
  https://stacks.cdc.gov/view/cdc/46664/cdc_46664_DS1.pdf
• File Type:
  [PDF - 359.78 KB ]