PREVENTION OF PNEUMOCYSTIS-CARINII PNEUMONIA - WHO ARE WE MISSING

Objective: To obtain population-based information on the characteristi cs of persons who were not receiving chemoprophylaxis against Pneumocy stis carinii pneumonia (PCP) by examining the use of primary and secon dary PCP prophylaxis among San Francisco residents whose AIDS-defining opportunistic illness was PCP in 1993. Design: Retrospective medical record review. Setting: Medical charts were obtained From San Francisc o hospitals and outpatient facilities at which AIDS patients received their initial AIDS diagnosis. Participants: San Francisco residents wh ose AIDS-defining opportunistic illness was PCP in 1993. Main outcome measures: Use of primary and secondary PCP prophylaxis. Results: Of th e 326 eligible patients, 35% received primary PCP prophylaxis. Nonwhit es were significantly less likely to have received primary PCP prophyl axis than white patients [22 versus 40%, respectively; odds ratio (OR) , 0.49195% confidence intervals (CI), 0.28-0.87]. Uninsured individual s were also less likely to have received primary PCP prophylaxis than those with insurance (18 versus 41%, OR, 0.35; 95% Cl, 0.17-0.73). The sociodemographic characteristics of patients who did and did not rece ive secondary PCP prophylaxis did not differ significantly. The most f requently cited reasons for not receiving primary PCP prophylaxis were that patients were unaware of their infection with HIV or were not re ceiving regular medical care. Conclusions: Barriers to receipt of PCP prophylaxis exist and are resulting in cases of preventable disease an d unnecessary medical costs. Interventions to increase counseling, tes ting, and referral to medical care for pet-sons at high risk for HIV i nfection are needed.