Clinician Practices and Attitudes Regarding Early Antiretroviral Therapy in the US

Kurth, Ann E.; Mayer, Kenneth; Beauchamp, Geetha; McKinstry, Laura; Farrior, Jennifer; Buchacz, Kate; Donnell, Deborah; Branson, Bernard; El-Sadr, Wafaa

doi:10.1097/qai.0b013e31826a184c

Cited by 7 publications

(9 citation statements)

References 24 publications

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“…However, it may also be the case that clinician decisions on initiating or continuing therapy favor patients more likely to improve their retention in care or those who have demonstrated stability in their clinic visit patterns (e.g., delaying ART initiation in IDU patients if they are actively using). [ 60 ] This does contradict reports of widespread clinician willingness to initiate therapy early in care among high risk patients, though in the largest such survey of clinician attitudes, the surveys were conducted only in New York and Washington, D.C.[ 61 ]…”

Section: Discussionmentioning

confidence: 99%

Geographic Variations in Retention in Care among HIV-Infected Adults in the United States

et al. 2016

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ObjectiveTo understand geographic variations in clinical retention, a central component of the HIV care continuum and key to improving individual- and population-level HIV outcomes.DesignWe evaluated retention by US region in a retrospective observational study.MethodsAdults receiving care from 2000–2010 in 12 clinical cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) contributed data. Individuals were assigned to Centers for Disease Control and Prevention (CDC)-defined regions by residential data (10 cohorts) and clinic location as proxy (2 cohorts). Retention was ≥2 primary HIV outpatient visits within a calendar year, >90 days apart. Trends and regional differences were analyzed using modified Poisson regression with clustering, adjusting for time in care, age, sex, race/ethnicity, and HIV risk, and stratified by baseline CD4+ count.ResultsAmong 78,993 adults with 444,212 person-years of follow-up, median time in care was 7 years (Interquartile Range: 4–9). Retention increased from 2000 to 2010: from 73% (5,000/6,875) to 85% (7,189/8,462) in the Northeast, 75% (1,778/2,356) to 87% (1,630/1,880) in the Midwest, 68% (8,451/12,417) to 80% (9,892/12,304) in the South, and 68% (5,147/7,520) to 72% (6,401/8,895) in the West. In adjusted analyses, retention improved over time in all regions (p<0.01, trend), although the average percent retained lagged in the West and South vs. the Northeast (p<0.01).ConclusionsIn our population, retention improved, though regional differences persisted even after adjusting for demographic and HIV risk factors. These data demonstrate regional differences in the US which may affect patient care, despite national care recommendations.

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Section: Discussionmentioning

confidence: 99%

Geographic Variations in Retention in Care among HIV-Infected Adults in the United States

et al. 2016

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“…These findings contrast with a recent study in which providers were concerned about the development of HIV resistance if ART was used to prevent HIV transmission. 14 Survey methodology has been used to assess provider knowledge, attitudes, and practices regarding prevention of perinatal HIV transmission, 15 as well as the use of ART to prevent HIV transmission. 14,16 In the current study, we used the KAP paradigm described by Cabana and colleagues.…”

Section: Discussionmentioning

confidence: 99%

“…14 Survey methodology has been used to assess provider knowledge, attitudes, and practices regarding prevention of perinatal HIV transmission, 15 as well as the use of ART to prevent HIV transmission. 14,16 In the current study, we used the KAP paradigm described by Cabana and colleagues. [17][18][19] In this paradigm, knowledge barriers include general lack of awareness of the guidelines or lack of familiarity with specific guidelines.…”

Section: Discussionmentioning

confidence: 99%

Initiation of Antiretroviral Therapy in Youth with HIV: A U.S.-Based Provider Survey

Gagliardo

Murray

Saiman

et al. 2013

AIDS Patient Care and STDs

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In 2009, the Department of Health and Human Services (DHHS) recommended initiating antiretroviral therapy (ART) for youth with HIV at higher CD4 counts ( £ 500 cells/mm 3 ) than previously recommended ( £ 350 cells/mm 3 ). Barriers experienced by providers regarding ART initiation in this population have not been assessed. From 12/ 2011-01/2012, we asked providers from the HIV Medicine Association listserv who prescribed ART to youth (ages 13-25 years) with behaviorally-acquired HIV to complete a web-based survey. We presented a clinical vignette to explore potential barriers for initiating ART. Overall, 274/290 (94%) respondents completed the survey. Most felt confident that evidence supported initiating ART at higher CD4 counts (94%), and that benefits outweighed the risks of long-term toxicity (98%) or developing resistance (88%). Most (96%) initiated ART in the patient vignette (age 19 years, CD4 count *400). Patient characteristics (e.g., unstable housing or drug use) were perceived as large barriers to ART initiation. Low response rate (13%) was a limitation. Respondents were knowledgeable about relevant DHHS guidelines, believed sufficient evidence supported ART initiation at higher CD4 counts, and would provide treatment to those with CD4 counts £ 500cells/mm 3 . Understanding and overcoming barriers to initiation of ART perceived by providers is important to ensure implementation of ART treatment guidelines.

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“…In addition to substance use, other patient-level factors have been cited as major barriers to providers’ willingness to initiate ART. HIV-related barriers have included: level of acceptance of HIV status and motivation to initiate ART [26, 28, 30, 31, 37]; and whether or not patients have disclosed HIV status to family or friends [36]. Psychosocial barriers have included: mental health issues [22, 26, 27, 31, 37, 38]; level of social support [37]; and general instability [22, 26, 36–38, 41], leading to missed medical appointments.…”

Section: Introductionmentioning

confidence: 99%

“It’s Never Just About the HIV:” HIV Primary Care Providers’ Perception of Substance Use in the Era of “Universal” Antiretroviral Medication Treatment

et al. 2017

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Antiretroviral therapy (ART) is recommended for all people living with HIV (PLWH), regardless of disease status. Substance use disorders (SUD) are common barriers to successful HIV treatment; however, few studies have comprehensively explored how HIV primary care providers take SUDs into account in the context of universal ART implementation. This study uses thematic analysis of qualitative interviews to explore providers' (N = 25) substance use assessment and factors associated with ART initiation. 64% of providers had 15 or more years of HIV treatment experience. Almost all providers agreed with the guidelines for universal ART initiation despite the presence of SUD. Still, identification and management of SUD is challenged by inconsistent assessment, providers' misperceptions about SUD and patients' willingness to discuss it, and lack of accessible treatment resources when SUD is identified. Greater guidance in systematic SUD assessment and management, combined with integrated addiction services, could enhance universal ART implementation among PLWH/SUD.

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Clinician Practices and Attitudes Regarding Early Antiretroviral Therapy in the US

Abstract: Background-Use of antiretroviral therapy (ART) to prevent HIV transmission has received substantial attention following a recent trial demonstrating efficacy of ART to reduce HIV transmission in HIV-discordant couples.

Cited by 7 publications

References 24 publications

Geographic Variations in Retention in Care among HIV-Infected Adults in the United States

Geographic Variations in Retention in Care among HIV-Infected Adults in the United States

Initiation of Antiretroviral Therapy in Youth with HIV: A U.S.-Based Provider Survey

“It’s Never Just About the HIV:” HIV Primary Care Providers’ Perception of Substance Use in the Era of “Universal” Antiretroviral Medication Treatment

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