Table 2.
Clinicians’ practices related to HIV prevention and treatment, HPTN065, 2010-2013.
| Baseline (n=165) | Follow-up (n=141) | P-value | |
|---|---|---|---|
| 1. How often do you ask about sexual partners? | |||
| Always | 80 (48.5%) | 74 (52.5%) | 0.44 |
| Often | 60 (36.4%) | 41 (29.1%) | |
| Occasionally | 18 (10.9%) | 18 (12.8%) | |
| Rarely | 3 (1.8%) | 5 (3.5%) | |
| Never | 0 (0.0%) | 1 (0.7%) | |
| 2. How often do you ask about sexual partners' HIV status? | |||
| Always | 61 (37.0%) | 65 (46.1%) | 0.16 |
| Often | 67 (40.6%) | 41 (29.1%) | |
| Occasionally | 25 (15.2%) | 26 (18.4%) | |
| Rarely | 8 (4.8%) | 6 (4.3%) | |
| Never | 0 (0.0%) | 1 (0.7%) | |
| 3. How often do you ask about use of condom? | |||
| Always | 95 (57.6%) | 79 (56.0%) | 0.72 |
| Often | 48 (29.1%) | 38 (27.0%) | |
| Occasionally | 16 (9.7%) | 18 (12.8%) | |
| Rarely | 2 (1.2%) | 3 (2.1%) | |
| Never | 0 (0.0%) | 1 (0.7%) | |
| 4. What percentage of your HIV-infected patients is currently on ART? | |||
| Median (Q1-Q3) | 85 (80-90) | 90 (80-95) | <0.001 |
| Mean Percentage (SD) | 83.0 (11.1) | 87.7 (13.7) | |
| Min, Max | 30, 100 | 0, 100 | |
| 5*. In which of the following scenarios would you generally recommend that ART be initiated for a typical HIV-infected patient? (Select all that apply) | |||
| a. Patient with CD4+ count ≤200 cells/mm3 | 147 (89.1%) | 95 (67.4%) | <0.001 |
| b. Patient with CD4+ count ≤350 cells/mm3 | 141 (85.5%) | 95 (67.4%) | <0.001 |
| c. Patient with CD4+ count ≤500 cells/mm3 | 92 (55.8%) | 96 (68.1%) | 0.03 |
| d. Patient with CD4 count > 500 cells/mm3 | -/-(-%) | 70 (49.6%) | NA |
| e. All patients irrespective of CD4+ cell count | 24 (14.5%) | 96 (68.1%) | <0.001 |
| f. Patient on tuberculosis treatment irrespective of CD4+ cell count | 107 (64.8%) | 100 (70.9%) | 0.31 |
| g. Patient with chronic hepatitis B irrespective of CD4+ cell count | 116 (70.3%) | 113 (80.1%) | 0.06 |
| h. Patient with chronic hepatitis C irrespective of CD4+ cell count | 76 (46.1%) | 101 (71.6%) | <0.001 |
| i. Patient with HIV associated nephropathy irrespective of CD4+cell count | 138 (83.6%) | 111 (78.7%) | 0.18 |
| j. Patient with HIV associated dementia irrespective of CD4+ cell count | 142 (86.1%) | 110 (78.0%) | 0.03 |
| k. Patient who is pregnant irrespective of CD4+ cell count | 152 (92.1%) | 113 (80.1%) | <0.001 |
| l. Other | 20 (12.1%) | 7 (5.0%) | 0.03 |
| 6. Which of the following factors would lead you to initiate ART earlier than you would otherwise? (Select all that apply) | |||
| a. Patients with high viral load (> 100,000 copies/mm3) | 129 (78.2%) | 109 (77.3%) | 0.72 |
| b. Patients with rapidly declining CD4+ cell count (>100 cells/mm3 per year) | 155 (93.9%) | 122 (86.5%) | 0.006 |
| c. Patients in an HIV discordant sexual partnership | 124 (75.2%) | 123 (87.2%) | 0.009 |
| d. Patient newly diagnosed with a sexually transmitted infection | 66 (40.0%) | 91 (64.5%) | <0.001 |
| e. Patients having unprotected sex with partner(s) of unknown HIV status | 105 (63.6%) | 115 (81.6%) | <0.001 |
| f. Other | 13 (7.9%) | 15 (10.6%) | 0.42 |
| 7. Early initiation of ART can slow the spread of HIV in a community by making patients less infectious to others | |||
| Strongly agree | 107 (64.8%) | 124 (87.9%) | <0.001 |
| Agree | 49 (29.7%) | 13 (9.2%) | |
| Disagree | 4 (2.4%) | 0 (0.0%) | |
| Strongly disagree | 0 (0.0%) | 0 (0.0%) | |
| 8. I am concerned that a patient will develop a resistant virus if ART is initiated too early. | |||
| Strongly agree | 7 (4.2%) | 2 (1.4%) | <0.001 |
| Agree | 65 (39.4%) | 24 (17.0%) | |
| Disagree | 67 (40.6%) | 76 (53.9%) | |
| Strongly disagree | 21 (12.7%) | 35 (24.8%) | |
| 9. If I start ART early in a patient with high risk sexual or other risk behaviors he or she may transmit resistant virus to his or her partners. | |||
| Strongly agree | 2 (1.2%) | 2 (1.4%) | 0.007 |
| Agree | 47 (28.5%) | 20 (14.2%) | |
| Disagree | 90 (54.5%) | 84 (59.6%) | |
| Strongly disagree | 21 (12.7%) | 31 (22.0%) | |
| 10. I am concerned that patients will develop side effects, toxicity or long term complications if ART is initiated too early. | |||
| Strongly agree | 7 (4.2%) | 1 (0.7%) | <0.001 |
| Agree | 73 (44.2%) | 28 (19.9%) | |
| Disagree | 71 (43.0%) | 84 (59.6%) | |
| Strongly disagree | 9 (5.5%) | 24 (17.0%) | |
| 11. I take into account my patient's sexual and other HIV transmission behavior when I recommend ART. | |||
| Strongly agree | 38 (23.0%) | 34 (24.1%) | 0.08 |
| Agree | 95 (57.6%) | 70 (49.6%) | |
| Disagree | 25 (15.2%) | 24 (17.0%) | |
| Strongly disagree | 2 (1.2%) | 9 (6.4%) | |
| 12. If a patient tells me that he or she is engaging in high risk behaviors, I am more likely to recommend initiating ART, irrespective of their CD4+ count. | |||
| Strongly agree | 38 (23.0%) | 58 (41.1%) | <0.001 |
| Agree | 79 (47.9%) | 62 (44.0%) | |
| Disagree | 41 (24.8%) | 14 (9.9%) | |
| Strongly disagree | 2 (1.2%) | 3 (2.1%) | |
| 13. I tend to defer ART if a patient is not sure whether he or she is ready to initiate it. | |||
| Strongly agree | 67 (40.6%) | 35 (24.8%) | 0.02 |
| Agree | 84 (50.9%) | 91 (64.5%) | |
| Disagree | 7 (4.2%) | 10 (7.1%) | |
| Strongly disagree | 2 (1.2%) | 1 (0.7%) | |
| 14. Because of concerns about a patient's inability to pay for ART, I tend to defer ART until a patient's CD4+ count is below 350. | |||
| Strongly agree | 1 (0.6%) | 0 (0.0%) | 0.02 |
| Agree | 11 (6.7%) | 2 (1.4%) | |
| Disagree | 62 (37.6%) | 43 (30.5%) | |
| Strongly disagree | 86 (52.1%) | 92 (65.2%) | |
| 15. Because ART reduces the risk of HIV transmission, I routinely recommend ART to my HIV-infected patients. | |||
| Strongly agree | -/-(-%) | 87 (61.7%) | N/A |
| Agree | -/-(-%) | 41 (29.1%) | |
| Disagree | -/-(-%) | 8 (5.7%) | |
| Strongly disagree | -/-(-%) | 1 (0.7%) | |
| 16. Please estimate the number of patients you yourself have initiated on ART in the past year | |||
| Median (Q1-Q3) | 10 (5-30) | 20 (8-36) | 0.04 |
| Mean (SD) | 25.9 (50.3) | 23.6 (21.0) | |
| Min, Max | 0, 500 | 0, 100 | |
| 17. Please estimate for how many of these patients you initiated on ART with the main goal of making it less likely that they would pass on HIV to their partners? | |||
| Median (Q1-Q3) | 0 (0-3) | 3 (0-8) | <0.001 |
| Mean (SD) | 5.1 (18.4) | 8.8 (15.8) | |
| Min, Max | 0, 200 | 0, 100 |
Note: The timeframes were: baseline (9/2010-5/2011) and follow-up (5/2013-12/2013).
The percentages may not add up to 100% for certain variables due to missing (refused) responses.
*
At baseline, this question was phrased: “In which of the following scenarios would you recommend that ART be initiated for HIV-infected patients in any circumstance?” and there was no option d.