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Systemic Delays in the Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients in Houston, Texas

Authors :
Osaro Mgbere PhD, MS, MPH
Maria Rodriguez-Barradas MD
Karen Joan Vigil MD
Melanie McNeese PhD, MPH
Fazal Tabassam BDS, PhD, MHA
Nadia Barahmani MD, PhD, MS
Jason Wang MPH
Raouf Arafat MD, MPH
Ekere James Essien MD, DrPH
Source :
Journal of the International Association of Providers of AIDS Care, Vol 17 (2018)
Publication Year :
2018
Publisher :
SAGE Publishing, 2018.

Abstract

Background: The current US HIV treatment guidelines support initiation of antiretroviral therapy (ART) for persons with HIV for personal health benefits and prevention of HIV transmission. However, high levels of adherence to ART are critical to maximize individual and public health benefits. We examined the nonclinical barriers to ART initiation for clinically eligible individuals and the provider- and patient-related factors associated with these barriers among HIV-infected patients in Houston/Harris County, Texas. Methods: We analyzed data obtained from a probability sample of HIV medical care providers (HMCPs) in 13 outpatient facilities in Houston/Harris County, Texas surveyed between June and September 2009. We used an inductive thematic approach to code HMCP responses to an open-ended question that asked the main reasons why providers may delay initiating ART for clinically eligible patients. Results: The reasons cited by providers for delaying ART for clinically eligible patients were adherence (42.5%; 95% confidence interval [CI]: 28.5-57.8), acceptance (30%; 95% CI: 18.1-45.4), and structural concerns (27.5%; 95% CI: 16.1-42.8), with significant variations ( P < .0001) noted across patients’ race/ethnicity and transmission category. HIV medical care providers with 6 to 10 years’ experience in HIV care and those providing medical care for more than 100 patients monthly were about 4 times (adjusted odds ratio [aOR]: 3.80; 95% CI: 1.20-5.92; P = .039) and 10 times (aOR: 10.36; 95% CI: 1.42-22.70; P = .019) more likely to state adherence and acceptance concerns, respectively, as reasons for delaying ART for clinically eligible patients. Conclusion: Our findings highlight the fact that clinical guidelines are only a starting point for medical decision-making process and that patients themselves play an important role. HMCP access to referrals for other medical issues, support services, and treatment education may help improve adherence and patient readiness for ART, thereby avoiding systemic delays.

Details

Language :
English
ISSN :
23259582
Volume :
17
Database :
Directory of Open Access Journals
Journal :
Journal of the International Association of Providers of AIDS Care
Publication Type :
Academic Journal
Accession number :
edsdoj.2136539cf76f4f52ae483cb0e262d6fd
Document Type :
article
Full Text :
https://doi.org/10.1177/2325958218774042