Trends in Provider-Advised HIV Antiretroviral Therapy Deferral in the United States, 2009-2014

Details

• Alternative Title:
  AIDS Care
• Personal Author:
  Beer, Linda ; Weiser, John ; Shouse, R. Luke
• Description:
  Since 2012, U.S. clinical guidelines for antiretroviral therapy (ART) initiation have recommended universal ART prescription barring patient contraindications. Although ART prescription has significantly increased among U.S. HIV patients in recent years, the reasons for this increase, and why some patients are still not taking ART, are not well characterized. To fill these gaps, we analyzed data from the Medical Monitoring Project (MMP), to assess the proportion of persons who reported provider-advised ART deferral during 2009-2014, and used bivariate linear regression to estimate linear trends in provider-advised ART deferral over time by patient characteristics and clinical setting. During this period, the proportion of patients reporting provider-advised ART deferral decreased from 67% to 40%. Significant decreases were observed in all patient subgroups and clinical settings. Patients recently reporting non-provider-advised reasons for ART deferral were significantly less likely to be virally suppressed and more likely to have inconsistent care, be depressed, binge drink, and use illicit drugs. This work suggests that U.S. providers are recommending ART deferral for fewer patients, consistent with increasing adoption of 2012 universal prescribing guidelines. Addressing patients' financial, mental health, and substance use barriers may be needed to achieve universal ART prescription in the United States.
• Subjects:
  Adult Anti-HIV Agents Antiretroviral Therapy, Highly Active Female Guideline Adherence Healthcare Disparities Health Services Accessibility HIV Infections Humans Male Middle Aged Physicians Practice Patterns, Physicians' Time-to-Treatment

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• Source:
  AIDS Care. 31(7):821-826
• Pubmed ID:
  30466314
• Pubmed Central ID:
  PMC6537092
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  31
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:47ae2ce5ce7444fc519a229058371efb379620e2194f07b51073c9879652911b
• Download URL:
  https://stacks.cdc.gov/view/cdc/79041/cdc_79041_DS1.pdf
• File Type:
  [PDF - 673.09 KB ]