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 language | English (US) |
|---|---|
| Pages (from-to) | 340-344 |
| Number of pages | 5 |
| Journal | Journal of Acquired Immune Deficiency Syndromes |
| Volume | 28 |
| Issue number | 4 |
| State | Published - Dec 1 2001 |
| Externally published | Yes |
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Keywords
- HIV guidelines
- HIV prevention
- HIV-positive
- MAC prophylaxis
- PCP prophylaxis
ASJC Scopus subject areas
- Virology
- Immunology
Cite this
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 journal › Article
}
TY - JOUR
T1 - Underuse of primary Mycobacterium avium complex and Pneumocystis carinii prophylaxis in the United States
AU - Asch, Steven M.
AU - Gifford, Allen L.
AU - Bozzette, Samuel A.
AU - Turner, Barbara
AU - Mathews, W. Chris
AU - Kuromiya, Kiyoshi
AU - Cunningham, William
AU - Andersen, Ron
AU - Shapiro, Martin
AU - Rastegar, Afshin
AU - McCutchan, J. Allen
PY - 2001/12/1
Y1 - 2001/12/1
N2 - 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.
AB - 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.
KW - HIV guidelines
KW - HIV prevention
KW - HIV-positive
KW - MAC prophylaxis
KW - PCP prophylaxis
UR - http://www.scopus.com/inward/record.url?scp=0035576145&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035576145&partnerID=8YFLogxK
M3 - Article
C2 - 11707670
AN - SCOPUS:0035576145
VL - 28
SP - 340
EP - 344
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
SN - 0894-9255
IS - 4
ER -