Physicians With Mostly Black Practice Test More for HIV

Daniel M. Keller, PhD

November 04, 2011

November 4, 2011 (Boston, Massachusetts) — Black physicians with a predominantly black practice are more likely to test their patients for HIV than are black physicians with a more racially mixed practice, Valerie Stone, MD, MPH, professor of medicine at Harvard Medical School and at Massachusetts General Hospital in Boston, Massachusetts, reported here at the Infectious Diseases Society of America (IDSA) 49th Annual Meeting.

Furthermore, from her first-of-its-kind survey of black primary care physicians treating mainly adults, Dr. Stone found that most of them would refer out patients who tested positive for HIV, but more physicians with a practice consisting of at least 75% black patients would provide the HIV care themselves.

Many black patients receive care from black physicians, and because the black community is disproportionately affected by HIV and AIDS, testing attitudes and behaviors of black physicians are important, she noted.

Therefore, Dr. Stone and colleagues assessed these factors by administering a questionnaire to attendees at the 2010 National Medical Association (NMA) Annual Convention, by email to physicians in the NMA Masterfile, and via an online panel to reach non-NMA physicians. Inclusion in the survey required physicians to have at least a 20% black patient base. Of more than 34,000 surveys distributed, 502 were completed.

"They greatly overestimated the extent of the HIV epidemic in their state and in their county," Dr. Stone said. "Almost half estimated it to be greater than 10% in their state and county when in fact there is no state or county in the United States with that level of HIV prevalence." On average, they estimated the prevalence at 13% to 14%, when in fact the highest prevalence, in Washington, DC, is about 3%.

Physicians with more black patients were more apt to overestimate their local and state HIV prevalence rates and to do more testing. In practices with at least 75% black patients, physicians tested more patients for HIV (40.1%) in the past year compared with practices with 20% to 40% black patients (23.5% tested; P < .05).

Overall, 34% of the practices' patients were tested in the past year: 67% of them because of a physician's recommendation and 33% by patient request. Rather than universal testing as recommended by the Centers for Disease Control and Prevention (CDC), much of the testing was risk-based.

"So it still wasn't nearly the universal testing pattern that we'd like to see, but it was better, and so we think that these physicians are at least moving in the direction of the CDC recommendations but still have a ways to go," Dr. Stone said.

Perceptions of HIV Epidemic by Black Physicians According to Proportion of Black Patients in Practice

Perception ≥75% Black Patients in Practice (%) 20% to <40% Black Patients in Practice (%)
Epidemic is crisis in the general US population 20 6
Epidemic is crisis in black community 63 48
HIV prevalence > 10% in your county 47 24
HIV prevalence > 10% in your state 45 32

"I think... there are a lot of physicians who are very anxious about having a positive test result and concerned that they don't know what to do if the test is positive," Dr. Stone told Medscape Medical News. "I just think that this issue of how to manage the HIV-positive result hasn't been focused on that frequently, but this was one of the main barriers that these physicians mentioned, and I think that that's where the education needs to focus."

She said many providers do not have strategies to deal with a positive test result, such as follow-up tests to perform (eg, CD4 count, viral load), which infectious disease specialist to refer, how to find a social worker or other mental health support, and getting partners and children tested.

"We think there's a lot of room for education of black physicians regarding how to manage an HIV-positive test result, how to let their patients know that they're interested in doing routine testing of all of them, perhaps by posters, brochures, that sort of thing, and also just giving them some case-based education to help them think about how they would actually do it on the ground with patients," Dr. Stone suggested.

Carlos Del Rio, MD, co-director of the Center for AIDS Research and professor of medicine and professor and chair of global health at the Rollins School of Public Health at Emory University in Atlanta, Georgia, said that because of their position of trust, physicians play a key role in influencing patients to be tested for HIV. And when a black provider has a largely black practice, they appear to do more HIV testing.

"They tend to say 'this is an important issue for us, for our community,' and they tend to be more likely to recommend HIV testing, and again, emphasizing that trust and the fact that a physician recommends a test, and you trust your physician, is probably the most important determinant of your wanting to be tested for something like HIV," Dr. Del Rio commented to Medscape Medical News.

The study was funded by Janssen Therapeutics. Edelman, a public relations firm, coordinated the study. Cheskin Added Value, a consulting and market research firm, provided analyses, and Medicus International, New York, provided production support. Dr. Stone has received consulting fees from Tibotec Therapeutics and from Gilead. Dr. Del Rio has disclosed no relevant financial relationships.

Infectious Diseases Society of America (IDSA) 49th Annual Meeting; Abstract #466. Presented on October 21, 2011.

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