title: Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States.
abstract: BACKGROUND
  Little is known about the rates of Mycobacterium avium complex (MAC) and Pneumocystis carinii (PCP) prophylaxis adherence to guidelines and how they have changed after introduction of effective antiretroviral therapy.
  
  
  OBJECTIVE
  To determine rates of primary prophylaxis for MAC and PCP and to evaluate the influence of sociodemographic characteristics, region, and provider experience.
  
  
  METHODS
  National probability sample cohort of HIV patients in care.
  
  
  METHODS
  One hundred sixty HIV health care providers.
  
  
  METHODS
  A total of 2864 patients interviewed in 1996 to 1997 (68% response) and 2267 follow-up interviews, representing 65% of surviving sampled patients (median follow-up, 15.1 months).
  
  
  METHODS
  Use of prophylactic drugs, most recent CD4 count, sociodemographics, and regional and total HIV patients/providers.
  
  
  RESULTS
  Of patients eligible for primary MAC prophylaxis (most recent CD4 count <50/mm(3) ), 41% at baseline and 40% at follow-up patients were treated. Of patients eligible for primary PCP prophylaxis (i.e., those with CD4 counts <200/mm(3) ), 64% and 72% were treated, respectively. MAC prophylaxis at baseline was less likely in African American (adjusted odds ratio [OR], 35; 95% confidence interval [CI], 0.20-0.59), Hispanic (OR, 27; 95% CI, 0.08-0.94) and less-educated (OR, 0.61; 95% CI, 0.36-1.0) patients and more likely in U. S. geographic regions in the Pacific West (OR, 4.9; 95% CI, 1.0-23) and Midwest (OR, 6.4; 95% CI, 1.2-33) and in practices with more HIV patients.
  
  
  CONCLUSIONS
  Most eligible patients did not receive MAC prophylaxis; PCP prophylaxis rates were better but still suboptimal. Our results support outreach efforts to African Americans, Hispanics, the less educated, and those in the northeastern United States and in practices with fewer HIV patients.
authors.affiliation: Veterans Administration Greater Los Angeles Health System, Los Angeles, California 90073, USA. sasch@rand.org
authors.forename: S M
authors.initials: SM
authors.lastname: Asch
authors.forename: A L
authors.initials: AL
authors.lastname: Gifford
authors.forename: S A
authors.initials: SA
authors.lastname: Bozzette
authors.forename: B
authors.initials: B
authors.lastname: Turner
authors.forename: W C
authors.initials: WC
authors.lastname: Mathews
authors.forename: K
authors.initials: K
authors.lastname: Kuromiya
authors.forename: W
authors.initials: W
authors.lastname: Cunningham
authors.forename: R
authors.initials: R
authors.lastname: Andersen
authors.forename: M
authors.initials: M
authors.lastname: Shapiro
authors.forename: A
authors.initials: A
authors.lastname: Rastegar
authors.forename: J A
authors.initials: JA
authors.lastname: McCutchan
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000453:epidemiology / Q000517:prevention & control*; D011010:Pneumocystis; D016720:Pneumocystis Infections / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology