Online Program

Disparities in prescribing behavior towards injection drug users living with HIV

Monday, November 4, 2013

Jennifer Hettema, Ph.D., Psychiatry and Neurobehavioral Sciences, University of Virginia, VA, VA
While adherence to antiretrovirals may be affected among injection drug users (IDUs), development of resistance among IDUs has not been found to be higher than in non-IDUs. Despite this, IDU status affects access to care for HIV patients, with evidence that provider reluctance to prescribe may contribute to this disparity. To determine the impact of IDU status on provider prescribing behavior, a national sample of community-based HIV providers completed an online survey in which they were presented with two case vignettes describing a patient with previous adherence issues presenting for treatment and requesting reinstatement of antiretrovirals. The vignettes were identical with the exception of the IDU status of the patient. Participants were randomly assigned to see either the IDU or non-IDU (NIDU) vignette first. 156 participants consented to participate in the study and 112 of these submitted complete responses. Participants were predominately female (55.8%), White (77.9%), and practicing in urban settings (80.5%). Independent samples t-tests revealed that neither IDU prescribing behavior (t(118)=-.258, p=.797) nor NIDU prescribing behavior (t(117)=-.693) differed significantly by condition (order of presentation). Consequently, conditions were collapsed for future analyses. A paired samples t-test was conducted to evaluate the impact of patient IDU status on prescribing behavior. There was a statistically significant difference between reported likelihood of prescribing for NIDU (M=3.51,SD=1.37) versus IDU patients (M=3.03, SD=1.37), t(115)=-5.03, p<.001. Attitudes towards shared decision-making and concerns about adherence were both predictive of willingness to prescribe to IDUs. Implications for provider training in substance abuse screening and brief intervention are discussed.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
Communication and informatics
Diversity and culture
Ethics, professional and legal requirements
Social and behavioral sciences

Learning Objectives:
Evaluate the impact of IDU status on HIV prescribing behavior.

Keyword(s): HIV/AIDS, Injection Drug Users

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a licensed clinical psychologist and assistant professor in the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia. She has extensive experience conducting research with HIV and substance using populations.
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.