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Clinician Perspectives on Delaying Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients

OBJECTIVES: Guidelines for antiretroviral therapy (ART) initiation have evolved, but consistently note that adherence problems should be considered and addressed. Little is known regarding the reasons providers delay ART initiation in clinically eligible patients. METHODS: In 2009, we surveyed a pro...

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Autores principales: Beer, Linda, Valverde, Eduardo E., Raiford, Jerris L., Weiser, John, White, Becky L., Skarbinski, Jacek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426141/
https://www.ncbi.nlm.nih.gov/pubmed/25394912
http://dx.doi.org/10.1177/2325957414557267
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author Beer, Linda
Valverde, Eduardo E.
Raiford, Jerris L.
Weiser, John
White, Becky L.
Skarbinski, Jacek
author_facet Beer, Linda
Valverde, Eduardo E.
Raiford, Jerris L.
Weiser, John
White, Becky L.
Skarbinski, Jacek
author_sort Beer, Linda
collection PubMed
description OBJECTIVES: Guidelines for antiretroviral therapy (ART) initiation have evolved, but consistently note that adherence problems should be considered and addressed. Little is known regarding the reasons providers delay ART initiation in clinically eligible patients. METHODS: In 2009, we surveyed a probability sample of HIV care providers in 582 outpatient facilities in the United States and Puerto Rico with an open-ended question about nonclinical reasons for delaying ART initiation in otherwise clinically eligible patients. RESULTS: Very few providers (2%) reported never delaying ART. Reasons for delaying ART were concerns about patient adherence (68%), patient acceptance (60%), and structural barriers (33%). Provider and practice characteristics were associated with reasons for delaying ART. CONCLUSION: Reasons for delaying ART were consistent with clinical guidelines and were both patient level and structural. Providers may benefit from training and access to referrals for ancillary services to enhance their ability to monitor and address these issues with their patients.
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spelling pubmed-44261412015-05-11 Clinician Perspectives on Delaying Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients Beer, Linda Valverde, Eduardo E. Raiford, Jerris L. Weiser, John White, Becky L. Skarbinski, Jacek J Int Assoc Provid AIDS Care Antiretroviral Therapy OBJECTIVES: Guidelines for antiretroviral therapy (ART) initiation have evolved, but consistently note that adherence problems should be considered and addressed. Little is known regarding the reasons providers delay ART initiation in clinically eligible patients. METHODS: In 2009, we surveyed a probability sample of HIV care providers in 582 outpatient facilities in the United States and Puerto Rico with an open-ended question about nonclinical reasons for delaying ART initiation in otherwise clinically eligible patients. RESULTS: Very few providers (2%) reported never delaying ART. Reasons for delaying ART were concerns about patient adherence (68%), patient acceptance (60%), and structural barriers (33%). Provider and practice characteristics were associated with reasons for delaying ART. CONCLUSION: Reasons for delaying ART were consistent with clinical guidelines and were both patient level and structural. Providers may benefit from training and access to referrals for ancillary services to enhance their ability to monitor and address these issues with their patients. SAGE Publications 2015-05 /pmc/articles/PMC4426141/ /pubmed/25394912 http://dx.doi.org/10.1177/2325957414557267 Text en © The Author(s) 2014 http://creativecommons.org/licenses/by-nc/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (http://www.uk.sagepub.com/aboutus/openaccess.htm).
spellingShingle Antiretroviral Therapy
Beer, Linda
Valverde, Eduardo E.
Raiford, Jerris L.
Weiser, John
White, Becky L.
Skarbinski, Jacek
Clinician Perspectives on Delaying Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients
title Clinician Perspectives on Delaying Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients
title_full Clinician Perspectives on Delaying Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients
title_fullStr Clinician Perspectives on Delaying Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients
title_full_unstemmed Clinician Perspectives on Delaying Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients
title_short Clinician Perspectives on Delaying Initiation of Antiretroviral Therapy for Clinically Eligible HIV-Infected Patients
title_sort clinician perspectives on delaying initiation of antiretroviral therapy for clinically eligible hiv-infected patients
topic Antiretroviral Therapy
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426141/
https://www.ncbi.nlm.nih.gov/pubmed/25394912
http://dx.doi.org/10.1177/2325957414557267
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