Use of protease inhibitors among persons with AIDS in Los Angeles County

We evaluated the access to, and the factors associated with, protease inhib itor use among persons with AIDS in Los Angeles County. A population-based sample of adult persons with AIDS is routinely interviewed in Los Angeles C ounty and includes a 30% random sample of men who have sex with men and all other persons reported with AIDS. Since May of 1996, all participants were asked if their physician had ever prescribed a protease inhibitor for thei r use. The possible association between protease inhibitor use and sociodem ographic, temporal and health care factors was assessed for the 12-month pe riod May 1996 through April 1997. Logistic regression was employed for mult ivariate analysis. Over the 12-month study period, 61.7% (209/339) persons interviewed reported that their physician had prescribed a protease inhibit or as part of their therapy. In bivariate analysis, treatment with protease inhibitor use was more common for whites (71.4%) and US-born Latinos (68.2 %) than blacks (53.4%) and foreign-born Latinos (56.6%), among person of hi gher income (71.2%) than lower (< $10,000) income (50.30%,), in those who r eported having insurance (66.70%) than those uninsured (47%) and among pers ons receiving care at private clinics (86.4%) than at HMOs (63.4%) or publi c clinics (55.2%). An increasing trend of protease inhibitor use with highe r educational level and declining CD4+ count was observed A temporal increa se was noted and this trend was most pronounced for persons receiving care at public clinics. In multivariate analysis, persons receiving care at priv ate facilities (adjusted OR = 2.9, 95% CI 1.0 8.2) and those with higher in comes (adjusted OX = 2.5, 95% CI 1.5, 4.3), were more likely to report that their physician had prescribed a protease inhibitor. The effect of facilit y type was modified by time. During the first six months of the study perio d (May 1996-October 1996) persons with AIDS receiving care at public facili ties and HMO sites were substantially less likely to report having been off ered a protease inhibitor (adjusted OR = 0.13, 95% CI 0.03, 0.58 and adjust ed OR = 0.23, 95% CI 0.05, 1.2, respectively). However, no significant faci lity-specific differences were observed over the last six-month period (Nov ember 1997-April 1997) evaluated. Our findings suggest that substantial dif ferences exist in the prescribing and use of protease inhibitors among pers ons with AIDS in Los Angeles County. Several factors, including facility of HIV care, calendar time, income, education level and level of immuno-suppr ession were independently associated with protease inhibitor use and sugges t the existence of important barriers to access. Efforts should be made to identify and remove barriers that will ensure the widest possible access to protease inhibitors for patients with a clinical indication for their use.