Increased prevention counseling by physicians who provide treatment for HIV-positive adults is a necessary ingredient in fighting the AIDS epidemic in the United States, according to findings of the Antiretroviral Treatment and Access Study (ARTAS) published in the July issue of the American Journal of Public Health. Findings indicate that overall, rates of HIV prevention counseling among physicians surveyed in Atlanta, Los Angeles, Baltimore and Miami were less than optimal, as physicians reported counseling newly diagnosed patients more than established patients. Factors associated with increased counseling included having sufficient time with patients and familiarity with treatment guidelines.
The ARTAS study, funded by the Centers for Disease Control and Prevention, was designed as a randomized trial of a case manager intervention to increase entry into care of newly diagnosed patients. As part of the study, investigators' studied physicians' delivery of HIV prevention counseling to both new and established HIV-positive patients.
Carlos del Rio, MD, professor of medicine in the Emory University School of Medicine's Division of Infectious Diseases, and chief of medical services at Grady Memorial Hospital, served as principal investigator for the Atlanta study site, and is one of the study's lead authors.
The article notes that 60 percent of physicians reported providing risk reduction counseling to 90 percent or more of their patients at the first encounter. This percentage decreased to 14 percent with established patients.
Dr. del Rio says that increases in high-risk sexual practices and sexually transmitted diseases among HIV-infected patients have prompted considerable concern over increased risk of transmission of HIV infection and have led to initiatives to increase STD screening and risk reduction measures for the HIV-infected population.
"Available evidence indicates that risk reduction counseling can be effective," Dr. del Rio says. "Unfortunately, results from this study showed that overall rates of counseling by physicians were low. This suggests that more education is needed to incorporate HIV prevention to medical care settings."
As part of the ARTAS study, 417 HIV care providers were mailed questionnaires to investigate if they spent time with their patients doing prevention counseling. Physicians who perceived their patients to have mental health and substance abuse problems, those who served primarily male patients, and those who were trained in infectious diseases were less likely to counsel patients.
"It is possible that patients received prevention counseling from another health care provider during their visit, but previous studies have indicated that physicians are an important source of information regarding HIV transmission and treatment," the authors write. "Lack of attention to HIV transmission behavior during a physician visit represents a missed opportunity for delivery of prevention messages."
The study authors included: Lisa R. Metsch, PhD, and Margaret Pereyra, Dr PH, Department of Epidemiology and Public Health, University of Miami School of Medicine, Miami, Fla.; Lytt Gardner, PhD, Division of HIV/AIDS, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta; Wayne A. Duffus, MD, formerly with the Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Gordon Dickinson, MD, Department of Medicine, University of Miami School of Medicine; Peter Kerndt, MD, and Pamela Anderson-Mahoney, PhD, The Health Research Association, Los Angeles, Calif.; and Steffanie A. Strathdee, formerly of the Johns Hopkins School of Hygiene and Public Health, Baltimore, Md.