High rates of deferring antiretroviral treatment for patients with HIV and substance use disorders: Results from a national sample of HIV physicians in Ukraine

• Published in: PloS one 2024-07, Vol.19 (7), p.e0305086
• Main Authors: Ottesen, Taylor D, Wickersham, Jeffrey A, Lawrence, Juliana C, Antoniak, Sergii, Zezuilin, Oleksandr, Polonsky, Maxim, Antonyak, Svitlana, Rozanova, Julia, Dvoriak, Sergii, Pykalo, Iryna, Filippovych, Myroslava, Altice, Fredrick L
• Format: Article
• Language: English
• Subjects: Adult; AIDS treatment; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiviral agents; Attitudes; CD4 antigen; CD4 Lymphocyte Count; Discrimination; Disorders; Drug therapy; Eastern Europe; Epidemics; Female; Health care policy; Health services; Heterosexuality; HIV; HIV (Viruses); HIV Infections - drug therapy; HIV Infections - epidemiology; HIV patients; Human immunodeficiency virus; Humans; Infectious diseases; Male; Measuring instruments; Medical students; Men; Methadone; Middle Aged; Mortality; Patient compliance; Patients; Physicians; Physicians - psychology; Populations; Practice Patterns, Physicians' - statistics & numerical data; Prejudice; Prescription writing; Prevention; Public health; Sexually transmitted diseases; Social Stigma; STD; Stereotypes; Stigma; Substance use; Substance-Related Disorders - epidemiology; Surveys; Surveys and Questionnaires; Thermometers; Thermometry; Transgender persons; Ukraine; Ukraine - epidemiology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0305086

HIV incidence and mortality are increasing in Ukraine despite their reductions globally, in part due to suboptimal antiretroviral therapy (ART) coverage in key populations of people with HIV (PWH) where the epidemic is concentrated. As physicians are gatekeepers to ART prescription, stigma and discrimination barriers are understudied as a key to meeting HIV treatment targets in key populations. A national sample (N = 204) of ART-prescribing physicians in Ukraine were surveyed between August and November 2019. Participants underwent a series of randomized, hypothetical HIV clinical scenarios and decided whether to initiate or defer (or withhold) ART. Scenarios varied based on 5 distinct CD4 counts (CD4: 17, 176, 305, 470, or 520 cells/mL) and 10 different PWH key populations. Z scores and McNemar's test for paired samples were used to assess differences between key populations and CD4 count. Feeling thermometers were used to assess stigma-related measures toward key populations among physicians. Physicians were highly experienced (mean = 19 years) HIV treaters, female (80.4%), and trained in infectious diseases (76.5%). Patients who drink alcohol (range: 21.6%-23.5%) or use (PWUD range: 16.7%-20.1%) or inject (PWID range: 15.5%-20.1%) drugs were most likely to have ART deferred, even at AIDS-defining CD4 counts. PWID maintained on methadone, however, were significantly (p