French general practitioners' attitudes toward therapeutic advances in HIVcare: results of a national survey

We aimed to assess attitudes to French primary care providers towards recen t advances in HIV care. Telephone surveys in a random sample of French gene ral practitioners (GPs) were carried out in April 1996 (response rate=70.3% ; n=1186). Only 40.5% of the sample had participated in the regular medical followup of HIV-infected patients during the previous year. Among these 48 0 respondents, only a few (13.3%) declared that they would take care of an asymptomatic patient with a high (>500 cells/mm(3)) CD4 count as the unique provider. A majority (66.2%) had referred at least one HIV-infected patien t to a hospital specialist In the previous year. A total of 31.4% declared that they considered it appropriate for an antiretroviral treatment to be i nitiated to an asymptomatic patient with 300 CD4 cells/mm3, and only 23.5% were already in favour of combination therapies rather than zidovudine mono therapy as treatment of choice. GPs with the most experience with HIV care tended to be the most reluctant to modify their attitude in favour of earli er initiation of antiretroviral therapies and of the switch from monotherap y to combination therapies. The survey suggests there is a gap between attitudes of GPs and those of AI DS specialists toward preliminary reports of therapeutic advances in HIV ca re. Whether or not such a gap may create problems for an appropriate diffus ion of new antiretroviral therapies should be carefully monitored, in the c ontext of current reforms emphasizing the key role of primary providers in most health-care systems.