Relation of physician specialty and HIV/AIDS experience to choice of guideline-recommended antiretroviral therapy

Background: Controversy exists regarding who should provide care for those with HIV/AIDS. While previous studies have found an association between phy sician HIV experience and patient outcomes, less is known about the relatio nship of physician specialty to HIV/AIDS outcomes or quality of care. Objective: To examine the relationship between choice of appropriate antire troviral therapy (ART) to physician specialty and HIV/AIDS experience. Design: Self-administered physician survey. Participants: Random sample of 2,478 internal medicine (IM) and infectious disease (ID) physicians. Measurements: Choice of guideline-recommended ART. Results: Two patients with HIV disease, differing only by CD4+ count and HI V RNA load, were presented, Respondents were asked whether ART was indicate d, and if so, what ART regimen they would choose. Respondents' ART choices were categorized as "recommended" or not by Department of Health and Human Services guidelines. Respondents' HIV/AIDS experience was categorized as mo derate to high (MOD/HI) or none to low (NO/LO). For Case 1, 72.9% of respon ding physicians chose recommended ART. Recommended ART was more Likely (P<. 01) to be chosen by ID physicians (88.2%) than by IM physicians (57.1%). Ph ysicians with MOD/HI experience were also more likely (P <.01) to choose re commended ART than those with NO/LO experience. Finally, choice of ART was examined using logistic regression: specialty and HIV experience were found to be independent predictors of choosing recommended ART (for ID physician s, odds ratio [OR], 4.66; 95% confidence interval [95% CI], 3.15 to 6.90; a nd for MOD/HI experience, OR, 2.05; 95% CI, 1.33 to 3.16). Results for Case 2 were similar. When the analysis was repeated excluding physicians who in dicated they would refer the HIV "patient," specialty and HIV experience we re not significant predictors of choosing recommended ART. Conclusions: Guideline-recommended ART appears to be less likely to be chos en by generalists and physicians with less HIV/AIDS experience, although ma ny of these physicians report they would refer these patients in clinical p ractice. These results lend support to current recommendations for routine expert consultant input in the management of those with HIV/AIDS.