Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States

Steven M. Asch, Allen L. Gifford, Samuel A. Bozzette, Barbara Turner, W. Chris Mathews, Kiyoshi Kuromiya, William Cunningham, Ron Andersen, Martin Shapiro, Afshin Rastegar, J. Allen McCutchan

Research output: Contribution to journalArticle

29 Citations (Scopus)

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. Design: National probability sample cohort of HIV patients in care. Setting: One hundred sixty HIV health care providers. Patients: 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). Measurements: 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/mm3), 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/mm3), 64% and 72% were treated, respectively. MAC prophylaxis at baseline was less likely in African American (adjusted odds ratio [OR], 35; 95% confidence interval ICI], 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.

Original languageEnglish (US)
Pages (from-to)340-344
Number of pages5
JournalJournal of Acquired Immune Deficiency Syndromes
Volume28
Issue number4
StatePublished - Dec 1 2001
Externally publishedYes

Fingerprint

Pneumocystis carinii
Mycobacterium avium Complex
Odds Ratio
HIV
CD4 Lymphocyte Count
Hispanic Americans
African Americans
Guideline Adherence
Sampling Studies
New England
Health Personnel
Patient Care

Keywords

  • HIV guidelines
  • HIV prevention
  • HIV-positive
  • MAC prophylaxis
  • PCP prophylaxis

ASJC Scopus subject areas

  • Virology
  • Immunology

Cite this

Asch, S. M., Gifford, A. L., Bozzette, S. A., Turner, B., Mathews, W. C., Kuromiya, K., ... McCutchan, J. A. (2001). Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States. Journal of Acquired Immune Deficiency Syndromes, 28(4), 340-344.

Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States. / Asch, Steven M.; Gifford, Allen L.; Bozzette, Samuel A.; Turner, Barbara; Mathews, W. Chris; Kuromiya, Kiyoshi; Cunningham, William; Andersen, Ron; Shapiro, Martin; Rastegar, Afshin; McCutchan, J. Allen.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 28, No. 4, 01.12.2001, p. 340-344.

Research output: Contribution to journalArticle

Asch, SM, Gifford, AL, Bozzette, SA, Turner, B, Mathews, WC, Kuromiya, K, Cunningham, W, Andersen, R, Shapiro, M, Rastegar, A & McCutchan, JA 2001, 'Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States', Journal of Acquired Immune Deficiency Syndromes, vol. 28, no. 4, pp. 340-344.
Asch SM, Gifford AL, Bozzette SA, Turner B, Mathews WC, Kuromiya K et al. Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States. Journal of Acquired Immune Deficiency Syndromes. 2001 Dec 1;28(4):340-344.
Asch, Steven M. ; Gifford, Allen L. ; Bozzette, Samuel A. ; Turner, Barbara ; Mathews, W. Chris ; Kuromiya, Kiyoshi ; Cunningham, William ; Andersen, Ron ; Shapiro, Martin ; Rastegar, Afshin ; McCutchan, J. Allen. / Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States. In: Journal of Acquired Immune Deficiency Syndromes. 2001 ; Vol. 28, No. 4. pp. 340-344.
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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. Design: National probability sample cohort of HIV patients in care. Setting: One hundred sixty HIV health care providers. Patients: 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). Measurements: 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/mm3), 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/mm3), 64{\%} and 72{\%} were treated, respectively. MAC prophylaxis at baseline was less likely in African American (adjusted odds ratio [OR], 35; 95{\%} confidence interval ICI], 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.",
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AU - Mathews, W. Chris

AU - Kuromiya, Kiyoshi

AU - Cunningham, William

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