In a three-year study of HIV-positive patients in Ontario, researchers report in the September/October Annals of Family Medicine that family doctors who take care of more HIV-positive patients in the context of their regular practice are more likely to adhere to antiretroviral therapy protocols than those who care for fewer.
Analyzing data on 13,417 HIV-positive patients, researchers found the majority (53 percent) saw family physicians exclusively for their care. Among these patients, those who saw a family physician with the highest level of HIV experience were almost twice as likely to receive ART as counterparts seeing less experienced family physicians. Specifically, the researchers found receipt of antiretroviral therapy was significantly lower among those receiving care from family physicians with five or fewer and six-49 HIV patients compared with those with 50 or more HIV patients, with a mean ART adherence (95 percent CI) of 0.34 (0.30-0.39) and 0.40 (0.34-0.45), respectively, versus 0.77 (0.74-0.80). Sixteen percent of the patients studied received care exclusively from family physicians with lower HIV experience, suggesting potential disparities in ART among these patients.
The authors note that cancer screening and health service use were not influenced by family physician HIV experience. They also note that the influence of family physician HIV experience appears to be mitigated by having an HIV specialist within the model of care.
Given these findings, the authors conclude that in order to ensure adequate ART prescribing, care delivery models for people with HIV should include either an HIV specialist or a family physician with considerable HIV experience.
By Claire E. Kendall, MD, MSc, et al
University of Ottawa, Ontario, Canada