Transcript Health Care Experiences of HIV+ Injection Drug Users

Clinician Practices in Assessing
Risk Behavior in US HIV Clinics
Carol Dawson Rose, Grant Colfax, Lisa Metsch, David
Mc Kirnan and Cari Courtenay-Quirk
Study Funded by CDC PPIP PA 01190
Objectives


Describe HIV primary care providers’ risk
assessment practices
Determine if risk assessment is more
frequent among patients with higher risk
practices
Methods
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HIV-infected patients in HIV primary care clinics in
Chicago, Miami, and San Francisco Bay Area enrolled
into a clinic-based prevention study in 2004-2005.
Recruited in clinic waiting rooms in 2204-2005.
Participants were asked about their clinicians’ risk
assessment practices.
Data were collected via audio-computer assisted
survey.
Methods
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
Risk behavior defined as:
In the previous 6 months, with an HIV-negative
or -unknown serostatus person(s):
– Had unprotected vaginal or anal intercourse
– Shared injection drug-related materials (i.e.
needles, cottons, cookers, water)
Clinician risk discussions defined as:
– Patient report of risk discussion with clinician at
most recent visit.
Demographic Characteristics N = 1048
City
Chicago
Miami
San Francisco
28%
41%
31%
Gender
Male
Female
Male to Female Transgender
77%
21%
2%
Mean Age (+sd)
Race/Ethnicity
African American
Caucasian
Latino
Mixed Race/Other
API
43 (+9)
47%
26%
22%
2%
<1%
Visits with HIV Primary Care Provider
Number of visits in 12 months
8
Median number of visits
5
Time Spent with HIV Primary Care Provider
At Last Visit
Less than 5 minutes
1%
Between 5-15 minutes
18%
Between 16-30 minutes
47%
Between 31-60 minutes
26%
More than 1 hour
8%
Sex Risk Behavior with Serodiscordant Partner
Patient Reported Risk Behavior



Women
Men, sex w/ men
Men, sex w/ women
55 (26%)
158 (19%)
38 (5%)
Injection Drug Use Risk



49 (4.8%) reported injection drug use with others
in the past 6 months
18 (1.8%) shared injection drug works in the past
6 months
15 (1.5%) shared injection drug works in the past
6 months with serodiscordant person(s)
What Did Patients Say Providers
Discussed?
Male
Female
MTF
80
70
60
50
40
30
20
10
0
If Sexually
Active
Transmission
Prevention
Are Providers Talking About Risk
with Patients who Report IDU Risk?
Adjusted OR
95% CI
Ref: IDU w /o risk
Had IDU risk
Adjusted for rac e and gender
3.9
1.37-11.45
Are Providers Able to Target Patients
with Sexual Risk?
Adjusted OR
Ref No Serodiscordant Risk
Had Unprotected Sex
Adjusted for rac e, and gender.
1.0
95% CI
0.69-1.44
Summary

By patient report, HIV clinicians’ are talking about prevention
with many of their patients
less likely to discuss risk with patients who report sexual risk
behavior, more likely to discuss risk with IDU.


Highlights need for clinicians to be trained on how to identify
and target risk discussion with patients who are engaging in
behavior that may be contributing to HIV transmission
Need for validated risk screener and risk assessment tool for
HIV clinician use
Collaborators
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University of California, San Francisco
Carol Dawson Rose, RN, PhD, Principal Investigator
Kelly Knight, MEd – Co-Investigator
Nicholas Alvarado, MPH, Project Director
Patrick Borch, BA - Field Coordinator
Charles Pearson, MA – Project Coordinator
San Francisco Department of Public Health
Grant Colfax, MD, Principal Investigator
Sarah Wheeler, MPH, Data Manager
University of Miami
Lisa Metsch, PhD, Principal Investigator
University of Chicago
David Mc Kirnan, PhD, Principal Investigator
Centers for Disease Control & Prevention
Dogan Eroglu, PhD - Project Officer
Cari Courtenay-Quirk, PhD – Study Coordianator