ArticleJournal of acquired immune deficiency syndromes (1999)2017
Barriers to Universal Prescribing of Antiretroviral Therapy by HIV Care Providers in the United States, 2013-2014.
Article in Journal of acquired immune deficiency syndromes (1999), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- Initiation of Antiretroviral Therapy in the Hospital Is Associated With Linkage to Human Immunodeficiency Virus (HIV) Care for Persons Living With HIV and Substance Use Disorder.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Trial
- Meeting Patients with Hepatitis C Where They Are: Lessons from the HIV Epidemic in the USA.Journal of general internal medicine · 2026Article
- Barriers to Rapid Enrollment and ART Initiation Among U.S. HIV Care Facilities.Journal of acquired immune deficiency syndromes (1999) · 2025Article
- The Association Of HIV With Health Care Spending And Use Among Medicare Beneficiaries.Health affairs (Project Hope) · 2022Article
- Gaps in the continuum of care among people living with HIV in Afghanistan.International journal of STD & AIDS · 2022Article
- Long-Term Mortality afterJournal of fungi (Basel, Switzerland) · 2021Article
- Human Immunodeficiency Virus-Experienced Clinician Workforce Capacity: Urban-Rural Disparities in the Southern United States.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- HIV Treatment Knowledge in the Context of "Treatment as Prevention" (TasP).AIDS and behavior · 2020Article
- Sustaining the HIV care provider workforce: Medical Monitoring Project HIV Provider Survey, 2013-2014.Health services research · 2019Article
- Barriers and Facilitators for Antiretroviral Treatment Adherence Among HIV-Positive African American and Latino Men Who Have Sex With Men.AIDS education and prevention : official publication of the International Society for AIDS Education · 2019Article
- Trends in provider-advised HIV antiretroviral therapy deferral in the United States, 2009-2014.AIDS care · 2019Article
- The Influence of Housing Status on the HIV Continuum of Care: Results From a Multisite Study of Patient Navigation Models to Build a Medical Home for People Living With HIV Experiencing Homelessness.American journal of public health · 2018Article
- "It's Never Just About the HIV:" HIV Primary Care Providers' Perception of Substance Use in the Era of "Universal" Antiretroviral Medication Treatment.AIDS and behavior · 2018Article
- Delivery of HIV Antiretroviral Therapy Adherence Support Services by HIV Care Providers in the United States, 2013 to 2014.Journal of the International Association of Providers of AIDS CareArticle
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
introductionHIV treatment guidelines recommend initiating antiretroviral therapy (ART) regardless of CD4 cell (CD4) count, barring contraindications or barriers to treatment. An estimated 6% of persons receiving HIV care in 2013 were not prescribed ART. We examined reasons for this gap in the care continuum.
methodsDuring 2013-2014, we surveyed a probability sample of HIV care providers, of whom 1234 returned surveys (64.0% adjusted response rate). We estimated percentages of providers who followed guidelines and their characteristics, and who deferred ART prescribing for any reason.
resultsBarring contraindications, 71.2% of providers initiated ART regardless of CD4 count. Providers less likely to initiate had caseloads ≤20 vs. >200 patients [adjusted prevalence ratios (aPR) 0.69, 95% confidence interval (CI): 0.47 to 1.02, P = 0.03], practiced at non-Ryan White HIV/AIDS Program-funded facilities (aPR 0.85, 95% CI: 0.74 to 0.98, P = 0.02), or reported pharmaceutical assistance programs provided insufficient medication to meet patients' needs (aPR 0.79, 95% CI: 0.65 to 0.98, P = 0.02). In all, 17.0% never deferred prescribing ART, 69.6% deferred for 1%-10% of patients, and 13.3% deferred for >10%. Among providers who had deferred ART, 59.4% cited patient refusal as a reason in >50% of cases, 31.1% reported adherence concerns because of mental health disorders or substance abuse, and 21.4% reported adherence concerns because of social problems, eg, homelessness, as factors in >50% of cases when deferring ART.
conclusionsAn estimated 29% of HIV care providers had not adopted recommendations to initiate ART regardless of CD4 count, barring contraindications, or barriers to treatment. Low-volume providers and those at non-Ryan White HIV/AIDS Program-funded facilities were less likely to follow this guideline. Among all providers, leading reasons for deferring ART included patient refusal and adherence concerns.
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