, Volume 19, Issue 11, pp 1146-1153

Does racial concordance between HIV-positive patients and their physicians affect the time to receipt of protease inhibitors?

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Abstract

BACKGROUND: Compared to whites, African Americans have been found to have greater morbidity and mortality from HIV, partly due to their lower use of effective antiretroviral therapy. Why racial disparities in antiretroviral use exist is not completely understood. We examined whether racial concordance (patients and providers having the same race) affects the time of receipt of protease inhibitors.

METHODS: We analyzed data from a prospective, cohort study of a national probability sample of 1,241 adults receiving HIV care with linked data from 287 providers. We examined the association between patient-provider racial concordance and time from when the Food and Drug Administration approved the first protease inhibitor to the time when patients first received a protease inhibitor.

RESULTS: In our unadjusted model, white patients received protease inhibitors much earlier than African-American patients (median 277 days compared to 439 days; P<.0001). Adjusting for patient characteristics only, African-American patients with white providers received protease inhibitors significantly later than African-American patients with African-American providers (median 461 days vs. 342 days respectively; P<.001) and white patients with white providers (median 461 vs. 353 days respectively; P=.002). In this model, no difference was found between African-American patients with African-American providers and white patients with white providers (342 vs. 353 days respectively; P>.20). Adjusting for patients’ trust in providers, as well as other patient and provider characteristics in subsequent models, did not account for these differences.

CONCLUSION: Patient-provider racial concordance was associated with time to receipt of protease inhibitor therapy for persons with HIV. Racial concordance should be addressed in programs, policies, and future racial and ethnic health disparity research.

Support for this study was provided by a grant to Dr. Wong from the Universitywide AIDS Research program #ID02-LA-031. Dr. Cunningham also received partial support from the UCLA-Drew Project Export, National Institutes of Health, National Center on Minority Health and Health Disparities (P20-MD00148-01), and the UCLA Center for Health Improvement in Minority Elders/Resource Centers for Minority Aging Research, National Institutes of Health, National Institute of Aging (AG-02-004).
Dr. King was partially supported by the UCLA Robert Wood Johnson Clinical Scholars Program and the Minority AIDS Training Program of the Adult AIDS Clinical Trial Group. The HIV Cost and Services Utilization Study was conducted under cooperative agreement U-01HS08578 (M.F. Shapiro, PI; S.A. Bozzette, Co-PI) between RAND and the Agency for Health Research and Quality. Substantial additional funding for this cooperative agreement was provided by the Health Resources and Services Administration, the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institutes of Health Office of Research on Minority Health through the National Institute of Dental Research. Additional support was provided by The Robert Wood Johnson Foundation, Merck and Company, Inc., Glaxo-Wellcome, Inc., the National Institute on Aging, the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, and the Mary and Irving Lazar Program in Health Services Research at UCLA.