AEGiS-APPJ: Careproviders' Adherence to HIV Standards of Care is Uniformly High in an Integrated HIV Care System

Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.

Careproviders' Adherence to HIV Standards of Care is Uniformly High in an Integrated HIV Care System

AIDS & Public Policy Journal 18, no. 1/2 (Spring/Summer 2003) 20-34.
Bruce Williams, Miranda Murray, Dale Harris, and Richard Conviser

PURPOSE: Several studies have reported that clinical experience is the most important predictor of careproviders' adherence to HIV standards of care. The purpose of this study was to determine if the importance of this association can be mitigated in a highly integrated network of HIV careproviders in which clinical support for even the most inexperienced practitioner is readily available.

METHODS: Existing quality management data (1998 - 2000) from an integrated, statewide Ryan White CARE (Comprehensive AIDS Resources Emergency) Act Title III program in New Mexico were analyzed to determine if a selected practice, careproviders' characteristics, or patients' characteristics were associated with careproviders' adherence to established standards of HIV care. Careproviders' characteristics included HIV expertise, practice location, specialty, and practice type. Patients' characteristics examined included gender, age, ethnicity/race, injection-drug use status, insurance source, HIV risk category, and CD4 cell count current at the time of chart abstraction. Standards tested included combination antiretroviral therapy, immunologic and virologic monitoring, opportunistic disease prophylaxis, prophylactic immunizations, and selected screening tests.

RESULTS: Overall, a high level of adherence to standards of HIV care was observed. No differences in adherence to standards that are considered to be essential to patients' clinical outcome (antiretroviral therapy, opportunistic disease prophylaxis, virologic and immunologic monitoring) were seen between careproviders by HIV experience, practice type, or specialty; or by any combination of patients' characteristics. Differences in adherence to serologic screening and prophylactic immunizations that favored certain clinicians (infectious diseases specialists) or settings (public or private, nonprofit clinics) may have been due to the more extensive use of clinical protocols among them.

CONCLUSIONS: Within a highly integrated and proactive HIV care system, a low level of experience and other parameters previously associated with suboptimal adherence to standards of HIV care may be ameliorated. This finding may have important implications for the design of HIV service delivery systems in the future.
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