Provider barriers to prescribing HAART to medically-eligible HIV-infected drug users

Abstract

We aimed to identify factors associated with a medical provider's resistance to prescribing HAART to medically-eligible HIV-infected illicit drug users. In four US cities, a mailed, self-administered survey queried 420 HIV care providers about patients’ characteristics and barriers to care. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were estimated using logistic regression. Providers identified as resistant to prescribing HAART to medically-eligible HIV-infected illicit drug users were more likely to be non-physicians (AOR=1.89, 95% CI: 1.04–3.46), to work in populations with a high prevalence of both mental illness (AOR=2.42; 95% CI: 1.11–5.26) and injection drug use (AOR=1.82 95% CI: 1.02–3.25) and were deterred from prescribing HAART by patients’ limited ability to keep appointments, (AOR=3.19; 95% CI: 1.39–7.37), alcoholism (AOR=1.92; 95% CI: 1.04–3.55) and homelessness (AOR=1.81; 95% CI: 1.07–3.06). Providers working in populations with a high injection drug use prevalence commonly reported higher prevalence of non-injection drug use, alcohol problems and mental illness, and higher antiretroviral therapy refusal rates within their patient populations. Our findings underscore the challenges to providers who treat HIV-infected drug users and suggest that their care and treatment would benefit from on-site drug treatment, mental health and social services.

Acknowledgments

The ARTAS group: Centers of Disease Control and Prevention: L. I. Gardner, PhD, S. Holmberg, MD; and C. S. Krawczyk, MPH, Emory University School of Medicine: C. del Rio, MD, S. Green, M. Barragan, MPH, W. Duffus, MD, PhD, C. Abrams, RN, F. Berry and V. Hunter; Johns Hopkins Bloomberg School of Public Health: S. A. Strathdee, PhD, A. M. Loughlin, PhD, S. Huettner, O. Burt and J. Reaves; Health Research Association: P. Kerndt, MD, P. Anderson-Mahoney, PhD, B. Gatson, B. Schmidt, MA, A. Chan, MPH, L. Fernandez, Jr., S. Curreri, E. Valera, S. Gutierrez, S. Hudson, PhD, T. Wafford and D. Norton, PhD, University of Miami School of Medicine: L. Metsch, PhD, C. McCoy, PhD, G. Dickinson, MD, T. Brewer, MD, O. Gomez, PhD, E. Valverde, MPH, B. Wohler-Torres, MS, L. Gooden, MPH, F. Yeomans and YD. Camacho; Wright State University School of Medicine: HA. Siegel, Ph.D., R. C. Rapp, MSW, T. L. Rust, MS, and J. Wang, PhD.