Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes
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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.
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.
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.
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).
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 WORDSculture ethnic groups HIV
This research was supported by a contract from the Health Resources and Services Administration and the Agency for Healthcare Research and Quality (AHRQ 290-01-0012). Representatives of both funding agencies were involved in the design of the study, but not in its conduct; in collection, management, analysis, or interpretation of the data; or in preparation, review, or approval of the manuscript. Drs. Saha, Moore, and Beach had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Saha was supported by the Department of Veterans Affairs. Dr. Beach was supported by the Agency for Healthcare Research and Quality (K08 HS013903-05), and both Drs. Saha and Beach were supported by Generalist Physician Faculty Scholar awards from the Robert Wood Johnson Foundation. Dr. Korthuis was supported by the National Institute on Drug Abuse (K23 DA019809). The views expressed in this article are those of the authors, and no official endorsement by the Agency for Healthcare Research and Quality, the Department of Veterans Affairs, or the U.S. Department of Health and Human Services is intended or should be inferred.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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