Provider barriers to prescribing HAART to medically-eligible HIV-infected drug users.
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.
Loughlin
A
A
Boston University School of Medicine, Maxwell Finland Laboratories, MA 02118, USA. aloughli@bu.edu
Metsch
L
L
Gardner
L
L
Anderson-Mahoney
P
P
Barrigan
M
M
Strathdee
S
S
D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D001291:Attitude of Health Personnel; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D016079:Refusal to Treat; D015819:Substance Abuse, Intravenous / Q000188:drug therapy; D019966:Substance-Related Disorders / Q000188:drug therapy