Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-6 (of 6 Records) |
Query Trace: West BT[original query] |
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Delivery of HIV antiretroviral therapy adherence support services by HIV care providers in the United States, 2013 to 2014
Weiser J , Beer L , Brooks JT , Irwin K , West BT , Duke CC , Gremel GW , Skarbinski J . J Int Assoc Provid AIDS Care 2017 16 (6) 2325957417729754 BACKGROUND: Little is known about clinicians' adoption of recommendations of the International Association of Providers of AIDS Care and others for supporting adherence to antiretroviral therapy (ART). METHODS: We surveyed a probability sample of US HIV care providers to estimate the percentage offering 3 ART adherence support services to most or all patients and assessed the characteristics of providers offering all 3 services (comprehensive support) to most or all patients. RESULTS: Almost all providers (95.5%) discussed ART adherence at every visit, 60.1% offered advice about tools to increase adherence, 53.5% referred nonadherent patients for supportive services, and 42.8% provided comprehensive support. Nurse practitioners were more likely to offer comprehensive support as were providers who practiced at Ryan White HIV/AIDS Program-funded facilities, provided primary care, or started caring for HIV-infected patients within 10 years. CONCLUSION: Less than half of HIV care providers offered comprehensive ART adherence support. Certain subgroups may benefit from interventions to increase delivery of adherence support. |
Retention in care services reported by HIV care providers in the United States, 2013 to 2014
Craw JA , Bradley H , Gremel G , West BT , Duke CC , Beer L , Weiser J . J Int Assoc Provid AIDS Care 2017 16 (5) 2325957417724204 OBJECTIVES: Evidence-based guidelines recommend that HIV care providers offer retention-in-care services, but data are needed to assess service provision. METHODS: We surveyed a probability sample of 1234 HIV care providers to estimate the percentage of providers whose practices offered 5 recommended retention services and describe providers' perceptions of barriers to care among patients. RESULTS: An estimated 21% of providers' practices offered all 5 retention services. Providers at smaller (<50 versus >400 patients), private, and non-Ryan White HIV/AIDS Program (RWHAP)-funded practices, and practices without on-site case management were significantly less likely to provide patient navigation services or do systematic monitoring of retention. Providers' most commonly perceived barriers to care among patients were mental health (40%), substance abuse (36%), and transportation (34%) issues. CONCLUSION: Deficiencies in the provision of key retention services are substantial. New strategies may be needed to increase the delivery of recommended retention services, especially among private, non-RWHAP-funded, and smaller facilities. |
Barriers to universal prescribing of antiretroviral therapy by HIV care providers in the United States, 2013-2014
Weiser J , Brooks JT , Skarbinski J , West BT , Duke CC , Gremel GW , Beer L . J Acquir Immune Defic Syndr 2016 74 (5) 479-487 INTRODUCTION: HIV treatment guidelines recommend initiating ART regardless of CD4 cell (CD4) count, barring contraindications or barriers to treatment. An estimated 6% of persons receiving HIV care in 2013 were not prescribed antiretroviral therapy (ART). We examined reasons for this gap in the care continuum. METHODS: During 2013-2014, we surveyed a probability sample of HIV care providers, of whom 1,234 returned surveys (64.0% adjusted response rate). We estimated percentages of providers who followed guidelines and their characteristics, and who deferred ART prescribing for any reason. RESULTS: Barring contraindications, 71.2% of providers initiated ART regardless of CD4 count. Providers less likely to initiate had caseloads ≤ 20 vs. >200 patients (adjusted prevalence ratios [aPR] 0.69, 95% confidence interval [CI] 0.47-1.02, P=.03), practiced at non-Ryan White HIV/AIDS Program (RWHAP)-funded facilities (aPR 0.85, 95% CI 0.74-0.98, P=.02), or reported pharmaceutical assistance programs provided insufficient medication to meet patients' needs (aPR 0.79, 95% CI 0.65-0.98, P=.02). In all, 17.0% never deferred prescribing ART, 69.6% deferred for 1-10% of patients, and 13.3% deferred for >10%. Among providers who had deferred ART, 59.4% cited patient refusal as a reason in >50% of cases; 31.1% reported adherence concerns due to mental health disorders or substance abuse and 21.4% reported adherence concerns due to social problems, e.g., homelessness, as factors in >50% of cases when deferring ART. CONCLUSIONS: An estimated 29% of HIV care providers had not adopted recommendations to initiate ART regardless of CD4 count, barring contraindications or barriers to treatment. Low-volume providers and those at non-RWHAP-funded facilities were less likely to follow this guideline. Among all providers, leading reasons for deferring ART included patient refusal and adherence concerns. |
Qualifications, demographics, satisfaction, and future capacity of the HIV care provider workforce in the United States, 2013-2014
Weiser J , Beer L , West BT , Duke CC , Gremel GW , Skarbinski J . Clin Infect Dis 2016 63 (7) 966-975 BACKGROUND: The U.S. HIV-infected population is increasing by about 30,000 annually (new infections minus deaths). With improvements in diagnosis and engagement in care, additional qualified HIV care providers may be needed. METHODS: We surveyed a probability sample of 2,023 U.S. HIV care providers in 2013-2014, including those at Ryan White HIV/AIDS Program (RWHAP)-funded facilities and in private practices. We estimated future patient care capacity by comparing counts of providers entering and planning to leave practice within five years, and the number of patients under their care. RESULTS: Of surveyed providers, 1,234 responded (adjusted response rate, 64%): 63% were white, 11% black, 11% Hispanic, and 16% other race/ethnicity; 37% were satisfied/very satisfied with salary/reimbursement, 33% were satisfied/very satisfied with administrative time. Compared to providers in private practice, more providers at RWHAP-funded facilities were HIV specialists (71% vs. 43%, p<.0001) and planned to leave HIV practice within five years (11% vs 4%, p=.0004). An estimated 190 more full-time equivalent (FTE) providers (defined as 40 HIV clinical care hours per week) entered practice in the past five years than expected to leave in the next five years. If these rates continue, by 2019 patient care capacity will increase by 65,000, compared to an increased requirement of at least 100,000. CONCLUSIONS: Projected workforce growth by 2019 will not accommodate the increased number of HIV-infected persons requiring care. RWHAP-funded facilities may face attrition of highly-qualified providers. Dissatisfaction with salary/reimbursement and administrative burden is substantial and black and Hispanic providers are underrepresented relative to HIV patients. |
Delivery of HIV transmission risk-reduction services by HIV care providers in the United States-2013
Beer L , Weiser J , West BT , Duke C , Gremel G , Skarbinski J . J Int Assoc Provid AIDS Care 2015 15 (6) 494-504 OBJECTIVES: Evidence-based guidelines have long recommended that HIV care providers deliver HIV transmission risk-reduction (RR) services, but recent data are needed to assess their adoption. METHODS: The authors surveyed a probability sample of 1234 US HIV care providers on delivery of 9 sexual behavior- and 7 substance use-related HIV transmission RR services and created an indicator of "adequate" delivery of services in each area, defined as performing approximately 70% or more of applicable services. RESULTS: Providers were most likely to encourage patients to disclose HIV status to all partners since HIV diagnosis (81%) and least likely to ask about disclosure to new sex and drug injection partners at follow-up visits (both 41%). Adequate delivery of sexual behavior- and substance use-related RR services was low (37% and 43%, respectively). CONCLUSION: The majority of US HIV care providers may need additional support to improve delivery of comprehensive HIV transmission RR services. |
Weighted multilevel models: a case study
West BT , Beer L , Gremel GW , Weiser J , Johnson CH , Garg S , Skarbinski J . Am J Public Health 2015 105 (11) e1-e2 Recent advances in statistical software have enabled public health researchers to fit multilevel models to a variety of outcome variables. Multilevel models facilitate inferences regarding unexplained variability among randomly sampled clusters of units (e.g., hospitals) in outcomes of interest and identify covariates that explain the variance in a given outcome at each level of a particular data hierarchy (e.g., patients within hospitals). Models with random intercepts enable researchers to accommodate correlations within higher-level units resulting from longitudinal or clustered study designs, and models with random coefficients enable researchers to identify higher-level covariates that explain between-cluster variance in relationships of interest. |
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