Disparities in prescribing behavior towards injection drug users living with HIV

While adherence to antiretrovirals may be affected among injection drug users (IDUs), development of resistance among IDUs has not been found to be higher than in non-IDUs. Despite this, IDU status affects access to care for HIV patients, with evidence that provider reluctance to prescribe may contribute to this disparity. To determine the impact of IDU status on provider prescribing behavior, a national sample of community-based HIV providers completed an online survey in which they were presented with two case vignettes describing a patient with previous adherence issues presenting for treatment and requesting reinstatement of antiretrovirals. The vignettes were identical with the exception of the IDU status of the patient. Participants were randomly assigned to see either the IDU or non-IDU (NIDU) vignette first. 156 participants consented to participate in the study and 112 of these submitted complete responses. Participants were predominately female (55.8%), White (77.9%), and practicing in urban settings (80.5%). Independent samples t-tests revealed that neither IDU prescribing behavior (t(118)=-.258, p=.797) nor NIDU prescribing behavior (t(117)=-.693) differed significantly by condition (order of presentation). Consequently, conditions were collapsed for future analyses. A paired samples t-test was conducted to evaluate the impact of patient IDU status on prescribing behavior. There was a statistically significant difference between reported likelihood of prescribing for NIDU (M=3.51,SD=1.37) versus IDU patients (M=3.03, SD=1.37), t(115)=-5.03, p<.001. Attitudes towards shared decision-making and concerns about adherence were both predictive of willingness to prescribe to IDUs. Implications for provider training in substance abuse screening and brief intervention are discussed.