Appropriateness of antiretroviral therapy in clients of an HIV/AIDS case management organization.

Holmes WC, Pace JL, Frank I. Appropriateness of antiretroviral therapy in clients of an HIV/AIDS case management organization. AIDS Care. 2007 Feb 1; 19(2):273-81.

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Abstract:

We sought to assess appropriateness of antiretroviral therapy (ART) reported by clients of an HIV/AIDS case management organization and identify variables associated with appropriate ART receipt. A total of 295 such clients were mailed a survey asking them to identify antiretroviral medications they were taking. Of them 220 (75%) returned surveys; 201 (93%) were taking antiretrovirals. Of these, 159 were on appropriate and 36 on inappropriate ART, as determined by guidelines created by the CDC, the International AIDS Society (USA Panel), and the Panel on Clinical Practices for Treatment of HIV Infection. In unadjusted analyses, age, sex, race, sexual orientation, history of injection drug use, history of sexual risk, and HIV knowledge were associated (p < or = 0.10) with appropriate ART and entered into one of two logistic regression models. The first model indicated that women (p = 0.003) and heterosexuals (p = 0.001) were less likely to receive appropriate ART than men and gay/bisexuals (and variables interacted, p = 0.001). HIV knowledge--a proxy indicator determined by self-report of a CD4 cell count and viral load--was added to variables retained in first model to create a second model. Only sexual orientation was retained in this second model (p = 0.02, in the same direction as in the first model), and those with less versus more HIV knowledge (p = 0.04) were found to be less likely to receive appropriate ART (and variables interacted, p = 0.04). Findings suggest that heterosexual men are less likely than women who, in turn, are less likely than gay/bisexual men to receive appropriate ART. HIV-related knowledge appears to increase likelihood of receiving appropriate ART and it attenuates the effect of sex.