228892 Provider-level correlates of suboptimal HIV care: Stigma and under-prescribing of antiretroviral thearpy to injection drug users

Tuesday, November 9, 2010 : 4:30 PM - 4:45 PM

Ryan Westergaard, MD, MPH , Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Bridget K. Ambrose, MPH , Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Mary Jonas, BA
Gregory Kirk, MD, MPH, PhD , Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Background: HIV-infected injection drug users (IDUs) tend to under-utilize antiretroviral therapy (ART). We investigated characteristics of HIV care providers associated with hesitancy to prescribe ART to medically-eligible IDUs. Methods: Clinicians in Maryland and Virginia who prescribed antiretroviral medications during 2009 were identified using pharmacy data available through a private marketing firm. Participants were invited to complete an online questionnaire regarding their practice characteristics, prescribing habits, attitudes and beliefs. Respondents indicated whether they were “likely” or “unlikely” to prescribe ART in a series of hypothetical clinical scenarios involving patients with CD4+ lymphocyte counts of various levels (200, 350 or 500 cells/µl) and varying intensity of drug use. Multiple logistic regression was used to calculate adjusted odds ratios (AORs) for the association between provider characteristics and self-reported unwillingness to prescribe ART. Results: Of 369 providers who responded to the survey, 71% were physicians trained in infectious diseases, 20% were in primary care specialties, and 8% were non-physicians. In multivariate analysis, factors associated with unwillingness to prescribe HAART to medically eligible IDUs included reporting negative attitudes towards drug users (AOR 2.5, 95% C.I. 1.6 – 4.2) and serving a patient population with prevalence of IDU >10% (1.8, 1.1 – 3.0). No differences in prescribing behavior were observed by specialty type, practice location (urban vs. rural), or years of clinical experience. Conclusions: Attitudes and beliefs of health care providers may contribute to under-prescription of ART for IDUs. Efforts to reduce disparities in HIV care should address stigmatization of drug users in health care settings.

Learning Areas:
Clinical medicine applied in public health
Diversity and culture
Social and behavioral sciences

Learning Objectives:
Describe characteristics of HIV care providers which may predict unwillingness to prescribe antiretroviral therapy to HIV-infected drug users. Identify targets for interventions to reduce barriers to appropriate HIV care for medically eligible injection drug users.

Keywords: HIV/AIDS, Intravenous Drug Use

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have traning in clinical HIV care and am completing a public health degree program focusing on HIV prevention.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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