Journal of General Internal Medicine

, Volume 19, Issue 4, pp 366–374

Disparities in HIV treatment and physician attitudes about delaying protease inhibitors for nonadherent patients

  • Mitchell D. Wong
  • William E. Cunningham
  • Martin F. Shapiro
  • Ronald M. Andersen
  • Paul D. Cleary
  • Naihua Duan
  • Hong Hu Liu
  • Ira B. Wilson
  • Bruce E. Landon
  • Neil S. Wenger
  • the HCSUS Consortium
Populations At Risk

DOI: 10.1111/j.1525-1497.2004.30429.x

Cite this article as:
Wong, M.D., Cunningham, W.E., Shapiro, M.F. et al. J GEN INTERN MED (2004) 19: 366. doi:10.1111/j.1525-1497.2004.30429.x

Abstract

BACKGROUND: Current HIV treatment guidelines recommend delaying antiretroviral therapy for nonadherent patients, which some fear may disproportionately affect certain populations and contribute to disparities in care.

OBJECTIVES: To examine the relationship of physician’s attitude toward prescribing protease inhibitors (PIs) to nonadherent patients with disparities in PI use and with health outcomes.

DESIGN: Prospective cohort study.

PATIENTS AND SETTING: A national probability sample of HIV-infected adults in the United States and their health care providers was surveyed between January 1996 and January 1998. We analyzed data on 1,717 patients eligible for PI treatment and the 367 providers who cared for them.

MEASUREMENTS: Providers’ attitude toward prescribing PIs to nonadherent patients, time until patients’ first receipt of PIs, mortality, and physical health status.

MAIN RESULTS: Eighty-nine percent of providers agreed that patient adherence is important in their decision to prescribe PIs (Selective) while 11% disagreed (Nonselective). Patients who had a Selective provider received PIs later than those with a Nonselective provider (P=.05). Adjusting for patient demographics and health characteristics and provider demographics, HIV knowledge, and experience, Latinos, women, and poor patients received PIs later if their provider had a Selective attitude but as soon as others if their provider had a Nonselective attitude. African-American patients received PIs later than whites, irrespective of their providers’ prescribing attitude. Patients with Selective providers had similar odds of mortality than those with Nonselective providers (odds ratio, 1.1; 95% confidence interval, 0.6 to 2.0), but had slightly worse adjusted physical health status at follow-up (49.1 vs 50.4, respectively; P=.04), after controlling for baseline physical health status and other patient and provider covariates.

CONCLUSIONS: Most providers consider patient adherence an important factor in their decision to prescribe PIs. This attitude appears to account for the relatively later use of PI treatment among Latinos, women, and the poor. Given the rising HIV infection rates among minorities, women, and the poor, further investigation of this treatment strategy and its impact on HIV resistance and outcomes is warranted.

Key words

African Americans health services accessibility HIV Latinos patient compliance 

Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • Mitchell D. Wong
    • 1
  • William E. Cunningham
    • 1
    • 2
  • Martin F. Shapiro
    • 1
    • 2
    • 3
  • Ronald M. Andersen
    • 2
  • Paul D. Cleary
    • 4
  • Naihua Duan
    • 6
  • Hong Hu Liu
    • 1
  • Ira B. Wilson
    • 5
  • Bruce E. Landon
    • 4
  • Neil S. Wenger
    • 1
    • 3
  • the HCSUS Consortium
  1. 1.Division of General Internal Medicine and Health Services ResearchUCLALos Angeles
  2. 2.School of Public HealthUniversity of CaliforniaLos Angeles
  3. 3.RANDSanta Monica
  4. 4.Department of Health Care PolicyHarvard Medical SchoolBoston
  5. 5.Division of Clinical Care ResearchTufts New England Medical CenterBoston
  6. 6.Department of PsychiatryUniversity of CaliforniaLos Angeles

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