Original Research

Journal of General Internal Medicine

, Volume 28, Issue 5, pp 622-629

Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes

  • Somnath SahaAffiliated withSection of General Internal Medicine, Portland VA Medical CenterDivision of General Internal Medicine & Geriatrics, Oregon Health & Science University Email author 
  • , P. Todd KorthuisAffiliated withDivision of General Internal Medicine & Geriatrics, Oregon Health & Science University
  • , Jonathan A. CohnAffiliated withDivision of Infectious Diseases, Department of Medicine, Wayne State University School of Medicine
  • , Victoria L. SharpAffiliated withCenter for Comprehensive Care, St. Luke’s-Roosevelt Hospital Center
  • , Richard D. MooreAffiliated withDivision of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine
  • , Mary Catherine BeachAffiliated withDivision of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine

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ABSTRACT

BACKGROUND

Health professional organizations have advocated for increasing the “cultural competence” (CC) of healthcare providers, to reduce racial and ethnic disparities in patient care. It is unclear whether provider CC is associated with more equitable care.

OBJECTIVE

To evaluate whether provider CC is associated with quality of care and outcomes for patients with HIV/AIDS.

DESIGN AND PARTICIPANTS

Survey of 45 providers and 437 patients at four urban HIV clinics in the U.S.

MAIN MEASURES

Providers’ self-rated CC was measured using a novel, 20-item instrument. Outcome measures included patients’ receipt of antiretroviral (ARV) therapy, self-efficacy in managing medication regimens, complete 3-day ARV adherence, and viral suppression.

KEY RESULTS

Providers’ mean age was 44 years; 56 % were women, and 64 % were white. Patients’ mean age was 45; 67 % were men, and 77 % were nonwhite. Minority patients whose providers scored in the middle or highest third on self-rated CC were more likely than those with providers in the lowest third to be on ARVs, have high self-efficacy, and report complete ARV adherence. Racial disparities were observed in receipt of ARVs (adjusted OR, 95 % CI for white vs. nonwhite: 6.21, 1.50–25.7), self-efficacy (3.77, 1.24–11.4), and viral suppression (13.0, 3.43–49.0) among patients of low CC providers, but not among patients of moderate and high CC providers (receipt of ARVs: 0.71, 0.32–1.61; self-efficacy: 1.14, 0.59–2.22; viral suppression: 1.20, 0.60–2.42).

CONCLUSIONS

Provider CC was associated with the quality and equity of HIV care. These findings suggest that enhancing provider CC may reduce racial disparities in healthcare quality and outcomes.

KEY WORDS

culture ethnic groups HIV