The Body Covers: The 36th Annual Meeting of the Infectious Diseases Society of America
Abstract 8: HIV Care Delivery in the U.S.
November 13, 1998
This abstract reviews current treatment practices by individuals who have prescribed antiretrovirals and provides important insight into the care of patients in an evolving epidemic. The study was a convenience phone interview survey of over 4,000 HIV treating physicians (from a sample of about 25,000 who prescribe ART). The sample population was divided into quintiles (N=476) based on number of prescriptions written. Quintiles were divided into five tiers with Tier 1 being the highest prescribers. Interestingly, 127 physicians prescribe 20% of all antiretrovirals (only 422 prescribe 40% of all antiretrovirals). Primary care physicians (internal medicine, family practice, and general practitioners) prescribe over half of all antiretrovirals; ID specialists prescribe only 38%. The lowest tiers (highest prescribers) prescribed ART for the largest number of patients: Tier 1 = 349 patients; Tier 2 = 267 patients; Tier 3 = 213 patients; Tier 4 = 97 patients; and, Tier 5 = 59 patients. Higher prescribers were also more likely to appropriately prescribe three or more antiretrovirals; the percentage who adhered to current guidelines by tier was as follows: Tier 1 = 87 %; Tier 2 = 77 %; Tier 3 = 79 %; Tier 4 = 74 %; and, Tier 5 = 60 %. The least experienced physicians (Tier 5) were also less likely to believe that double nucleoside therapy was contraindicated and more likely to initiate therapy at a later stage of disease (HIV-1 RNA levels of 32,000 copies/mL vs. ~10,000 copies for all other tiers). Women and people of color (the very groups who have not derived the same benefit from HAART as have white men) were more likely to be treated by physicians in Tiers 3, 4 and 5 (68% of their patients were of minority status). The proportion of women (36%) and minorities (42%) were more likely to have symptomatic HIV compared to white men (27%). These findings suggest that women and minorities are more likely to be treated for their HIV by less experienced physicians, and are more likely to be started on therapy at a later stage of disease. Therefore, these individuals are not likely to achieve the same success that patients treated by more HIV experienced clinicians have achieved. Of course, this along with other studies, adds fuel to the fire for implementing guidelines by the new HIV Care Association, however does not answer the question as to who should be caring for the patients in the constantly evolving epidemic of HIV as it expands further into the heterosexual, drug using and rural areas in the South where care, in general, is lacking for most marginalized individuals.
Authored by: Bartlett JG and Volberding P
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