Systemic Delays in the Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients in Houston, Texas: The Providers' Report Card

Overview

Journal J Int Assoc Provid AIDS Care

Publisher Sage Publications

Specialty Infectious Diseases

Date 2018 May 11

PMID 29745311

Citations 1

Authors

Osaro Mgbere

Maria Rodriguez-Barradas

Karen Joan Vigil

Melanie McNeese

Fazal Tabassam

Nadia Barahmani

Jason Wang

Raouf Arafat

Ekere James Essien

Affiliations

Soon will be listed here.

Abstract

Background: The current US HIV treatment guidelines support initiation of antiretroviral therapy (ART) for persons with HIV for personal health benefits and prevention of HIV transmission. However, high levels of adherence to ART are critical to maximize individual and public health benefits. We examined the nonclinical barriers to ART initiation for clinically eligible individuals and the provider- and patient-related factors associated with these barriers among HIV-infected patients in Houston/Harris County, Texas.

Methods: We analyzed data obtained from a probability sample of HIV medical care providers (HMCPs) in 13 outpatient facilities in Houston/Harris County, Texas surveyed between June and September 2009. We used an inductive thematic approach to code HMCP responses to an open-ended question that asked the main reasons why providers may delay initiating ART for clinically eligible patients.

Results: The reasons cited by providers for delaying ART for clinically eligible patients were adherence (42.5%; 95% confidence interval [CI]: 28.5-57.8), acceptance (30%; 95% CI: 18.1-45.4), and structural concerns (27.5%; 95% CI: 16.1-42.8), with significant variations ( P < .0001) noted across patients' race/ethnicity and transmission category. HIV medical care providers with 6 to 10 years' experience in HIV care and those providing medical care for more than 100 patients monthly were about 4 times (adjusted odds ratio [aOR]: 3.80; 95% CI: 1.20-5.92; P = .039) and 10 times (aOR: 10.36; 95% CI: 1.42-22.70; P = .019) more likely to state adherence and acceptance concerns, respectively, as reasons for delaying ART for clinically eligible patients.

Conclusion: Our findings highlight the fact that clinical guidelines are only a starting point for medical decision-making process and that patients themselves play an important role. HMCP access to referrals for other medical issues, support services, and treatment education may help improve adherence and patient readiness for ART, thereby avoiding systemic delays.

Citing Articles

Implementation of "Treat-all" at adult HIV care and treatment sites in the Global IeDEA Consortium: results from the Site Assessment Survey.

Brazier E, Maruri F, Duda S, Tymejczyk O, Wester C, Somi G J Int AIDS Soc. 2019; 22(7):e25331.

PMID: 31623428 PMC: 6625339. DOI: 10.1002/jia2.25331.

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