Delivery of HIV Antiretroviral Therapy Adherence Support Services by HIV Care Providers in the United States, 2013 to 2014

Weiser, John; Beer, Linda; Brooks, John T.; Irwin, Kathleen L.; West, Brady T.; Duke, Chris; Gremel, Garrett W.; Skarbinski, Jacek

doi:10.1177/2325957417729754

Cited by 10 publications

(9 citation statements)

References 24 publications

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“…Another analysis of MMP provider survey data observed that these providers were also less likely to report delivering recommended ART adherence support to patients than providers at RWHAP-funded facilities. 35 These findings suggest a need to support non-RWHAP providers in addition to low-volume providers to adopt currently recommended ART prescribing practices.…”

Section: Discussionmentioning

confidence: 99%

Barriers to Universal Prescribing of Antiretroviral Therapy by HIV Care Providers in the United States, 2013–2014

Weiser

Brooks

Skarbinski

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction HIV 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. Methods During 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. Results Barring 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. Conclusions An 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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Section: Discussionmentioning

confidence: 99%

Barriers to Universal Prescribing of Antiretroviral Therapy by HIV Care Providers in the United States, 2013–2014

Weiser

Brooks

Skarbinski

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…44 However, since they had achieved viral suppression, there may be an opportunity to leverage their interactions with their healthcare providers to support the management of other comorbidities. For example, since HIV care guidelines recommend that HIV providers monitor and support ART adherence, 20 , 21 future research should focus on adapting and tailoring these evidence-based practices to support CVD medication adherence for PLWH who have achieved viral suppression.…”

Section: Discussionmentioning

confidence: 99%

“…On the healthcare provider level, HIV healthcare providers have an important role in encouraging and monitoring ART adherence as described in their practice guidelines. 20 , 21 HIV providers’ role in monitoring and encouraging adherence to other non-AIDS conditions such as CVD for PLWH who have achieved viral suppression is understudied. At the individual patient level, Cioe et al found that in a study of PLWH, greater than 90% of the participants knew that smoking, being overweight, high cholesterol and lack of exercise contributed to an increased risk of heart disease, but this knowledge was not associated with perceived risk of CVD.…”

Section: Introductionmentioning

confidence: 99%

<p>Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry</p>

Muiruri¹,

Sico²,

Schexnayder³

et al. 2020

PPA

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Background: After achieving viral suppression, it is critical for persons living with HIV (PLWH) to focus on prevention of non-AIDS comorbidities such as cardiovascular disease (CVD) in order to enhance their quality of life and longevity of life. Despite PLWH elevated risk of developing CVD compared to individuals without HIV, PLWH do not often meet evidence-based treatment goals for CVD prevention; the reasons for PLWH not meeting guideline recommendations are poorly understood. The objective of this study was to identify the factors associated with adherence to CVD medications for PLWH who have achieved viral suppression. Methods: Qualitative data were obtained from formative research conducted to inform the adaptation of a nurse-led intervention trial to improve cardiovascular health at three large academic medical centers in the United States. Transcripts were analyzed using content analysis guided by principles drawn from grounded theory. Results: Fifty-one individuals who had achieved viral suppression (<200 copies/mL) participated: 37 in 6 focus groups and 14 in individual semi-structured interviews. Mean age was 57 years (SD: 7.8); most were African Americans (n=31) and majority were male (n=34). Three main themes were observed. First, participants reported discordance between their healthcare providers' recommendations and their own preferred strategies to reduce CVD risk. Second, participants intentionally modified frequency of CVD medication taking which appeared to be related to low CVD risk perception and perceived or experienced side effects with treatment. Finally, participants discussed the impact of long-term experience with HIV care on adherence to CVD medication and motivational factors that enhanced adherence to heart healthy behaviors. Conclusion: Findings suggest that future research should focus on developing interventions to enhance patient-provider communication in order to elicit beliefs, concerns and preferences for CVD prevention strategies. Future research should seek to leverage and adapt established evidence-based practices in HIV care to support CVD medication adherence.

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“…Accordingly, numerous interventions have been employed to improve medication taking . In the US, almost all HIV care providers reported discussing ART adherence at every visit, and more than half of them referred non‐adherent patients for adherence support services .…”

Section: Introductionmentioning

confidence: 99%

Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study

et al. 2019

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Introduction Adherence to antiretroviral therapy ( ART ) is essential to reduce HIV ‐related morbidity and mortality as well as the risk of virological failure and HIV transmission. We determined the trends in ART adherence during the periods of therapeutic advances, wider use of ART and greater attention to ART adherence. To understand the general trends in medication adherence, we compared ART adherence with medications for other common chronic conditions. Methods A retrospective cohort study using Medicaid claims between 2001 and 2012 from 14 US states with the highest HIV prevalence. Medicaid is the largest source of care for HIV patients in the US . We identified Medicaid beneficiaries with HIV who initiated ART between 2001 and 2010 (n=23,343). Comparison groups included (1) HIV ‐ persons who initiated a statin, angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker ( ACEI / ARB ), or metformin and (2) HIV + persons who initiated these control medications while on and not on ART . We estimated adjusted odds of >90% medication implementation during the two years following initiation. Results The proportion of HIV + persons with >90% ART implementation increased from 33.5% in those who initiated in 2001 to 46.4% in 2005 and 52.4% in 2010. ART initiators in 2007 to 2010 had 53% increased odds of >90% implementation compared to those in 2001 to 2003 (adjusted OR 1.53, 99% CI : 1.34 to 1.75). Older age, male, White race, newer ART regimens and absence of substance use indicators were also associated with increased odds of >90% ART implementation. No or minimal improvements were found in the implementation of control medications in HIV ‐ persons. For HIV ‐ persons, the adjusted OR s comparing 2007–2010 to 2001–2003 were 1.06, 1.01 and 1.19 for statins, ACEI / ARB , metformin respectively. HIV + persons who were on ART had, on average, 15.0 ( SD : 4.2) and 16.1 ( SD : 3.4) percentage points higher >90% implementation rates of concurrent statins, ACEI / ARB ...

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Delivery of HIV Antiretroviral Therapy Adherence Support Services by HIV Care Providers in the United States, 2013 to 2014

Cited by 10 publications

References 24 publications

Barriers to Universal Prescribing of Antiretroviral Therapy by HIV Care Providers in the United States, 2013–2014

Barriers to Universal Prescribing of Antiretroviral Therapy by HIV Care Providers in the United States, 2013–2014

<p>Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? A Qualitative Inquiry</p>

Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study

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