High rates of deferring antiretroviral treatment for patients with HIV and substance use disorders: Results from a national sample of HIV physicians in Ukraine

HIV incidence and mortality are increasing in Ukraine despite their reductions globally, in part due to suboptimal antiretroviral therapy (ART) coverage in key populations of people with HIV (PWH) where the epidemic is concentrated. As physicians are gatekeepers to ART prescription, stigma and discr...

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Bibliographic Details
Published in:PloS one 2024-07, Vol.19 (7), p.e0305086
Main Authors: Ottesen, Taylor D, Wickersham, Jeffrey A, Lawrence, Juliana C, Antoniak, Sergii, Zezuilin, Oleksandr, Polonsky, Maxim, Antonyak, Svitlana, Rozanova, Julia, Dvoriak, Sergii, Pykalo, Iryna, Filippovych, Myroslava, Altice, Fredrick L
Format: Article
Language:English
Subjects:
AIDS treatment
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Antiviral agents
Attitudes
CD4 antigen
Discrimination
Disorders
Drug therapy
Eastern Europe
Epidemics
Health care policy
Health services
Heterosexuality
HIV
HIV (Viruses)
HIV patients
Human immunodeficiency virus
Infectious diseases
Measuring instruments
Medical students
Men
Methadone
Mortality
Patient compliance
Patients
Physicians
Populations
Prejudice
Prescription writing
Prevention
Public health
Sexually transmitted diseases
STD
Stereotypes
Stigma
Substance use
Surveys
Thermometers
Thermometry
Transgender persons
Ukraine
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Summary:HIV incidence and mortality are increasing in Ukraine despite their reductions globally, in part due to suboptimal antiretroviral therapy (ART) coverage in key populations of people with HIV (PWH) where the epidemic is concentrated. As physicians are gatekeepers to ART prescription, stigma and discrimination barriers are understudied as a key to meeting HIV treatment targets in key populations. A national sample (N = 204) of ART-prescribing physicians in Ukraine were surveyed between August and November 2019. Participants underwent a series of randomized, hypothetical HIV clinical scenarios and decided whether to initiate or defer (or withhold) ART. Scenarios varied based on 5 distinct CD4 counts (CD4: 17, 176, 305, 470, or 520 cells/mL) and 10 different PWH key populations. Z scores and McNemar's test for paired samples were used to assess differences between key populations and CD4 count. Feeling thermometers were used to assess stigma-related measures toward key populations among physicians. Physicians were highly experienced (mean = 19 years) HIV treaters, female (80.4%), and trained in infectious diseases (76.5%). Patients who drink alcohol (range: 21.6%-23.5%) or use (PWUD range: 16.7%-20.1%) or inject (PWID range: 15.5%-20.1%) drugs were most likely to have ART deferred, even at AIDS-defining CD4 counts. PWID maintained on methadone, however, were significantly (p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0305086