Trends in provider-advised HIV antiretroviral therapy deferral in the United States, 2009–2014

ABSTRACT

Since 2012, U.S. clinical guidelines for antiretroviral therapy (ART) initiation have recommended universal ART prescription barring patient contraindications. Although ART prescription has significantly increased among U.S. HIV patients in recent years, the reasons for this increase, and why some patients are still not taking ART, are not well characterized. To fill these gaps, we analyzed data from the Medical Monitoring Project (MMP), to assess the proportion of persons who reported provider-advised ART deferral during 2009–2014, and used bivariate linear regression to estimate linear trends in provider-advised ART deferral over time by patient characteristics and clinical setting. During this period, the proportion of patients reporting provider-advised ART deferral decreased from 67% to 40%. Significant decreases were observed in all patient subgroups and clinical settings. Patients recently reporting non-provider-advised reasons for ART deferral were significantly less likely to be virally suppressed and more likely to have inconsistent care, be depressed, binge drink, and use illicit drugs. This work suggests that U.S. providers are recommending ART deferral for fewer patients, consistent with increasing adoption of 2012 universal prescribing guidelines. Addressing patients’ financial, mental health, and substance use barriers may be needed to achieve universal ART prescription in the United States.

KEYWORDS:

• Human immunodeficiency virus
• HIV
• antiretroviral therapy
• ART
• antiretroviral therapy initiation

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Portions of this work were presented at the 12th International Conference on HIV Treatment and Prevention Adherence in June 2017 in Miami, FL, USA.

Acknowledgements

The Medical Monitoring Project (MMP) is funded by the U.S. Centers for Disease Control and Prevention. We thank participating MMP patients, facilities, project areas, and Provider and Community Advisory Board members. We also acknowledge the contributions of the Clinical Outcomes Team and Behavioral and Clinical Surveillance Branch at CDC.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.