2015 APHA Annual Meeting & Expo

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Online Program

317413
Art of ART Initiation: Clinician Perspectives on Prescribing Anti-Retroviral Therapy


Tuesday, November 3, 2015 : 3:30 p.m. - 3:50 p.m.

Erin DeMicco, MPH, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA
Tim Matheson, PhD, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA
Shannon Huffaker, NP, Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA
Audio (mp3) recording Recorded Presentation (mp4)
Anti-retroviral treatment (ART) reduces HIV-associated morbidity and mortality and decreases perinatal and sexual transmission. In 2012, the Department of Health and Human Services recommended the universal offer of ART to all HIV positive persons, a policy that has been in place in San Francisco since 2010. While providers in San Francisco have embraced earlier ART, initiation rates vary and tend to be lower in African-American and substance-using populations.

The purpose of this project was to understand clinicians’ practices of prescribing ART, including the barriers and facilitators to early ART initiation, and how they define “treatment readiness.” Twenty HIV clinicians participated in seven roundtable discussions.

Results suggest that most participants are proponents of a universal offer of ART. They cited urgent health needs, long-term health benefits, and reduced transmission risk as reasons to begin treatment, regardless of CD4 count or viral load. However, a few providers were hesitant to prescribe immediate ART without having additional clinical information, such as a viral load or genotype.

“Treatment readiness” was cited as a decisive factor for prescribing ART.  Components of “treatment readiness” included: acceptance of diagnosis, access to medications, and the ability to adhere to treatment.

Immediate ART is a key strategy in the plan to eradicate new infections in San Francisco. Clinicians’ beliefs and practices for prescribing ART impact the scope and effectiveness of this strategy. Resources are needed to train clinicians on the benefits of immediate ART initiation and to support patients who choose to begin treatment immediately after diagnosis.

Learning Areas:

Chronic disease management and prevention
Provision of health care to the public

Learning Objectives:
Explain the Department of Health and Human Services guidelines for prescribing ART to HIV positive persons. List three reasons clinicians recommend beginning ART immediately after HIV diagnosis. Identify two components of “treatment readiness.”

Keyword(s): HIV Interventions, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Project Director with the San Francisco Department of Public Health and have worked in HIV research for six years. My specific interest is in immediate ART for long term individual health benefits and for the public health benefit of using treatment as a prevention strategy.
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.

Back to: 4324.0: HIV Viral Load Suppression