Short-term HIV outcomes differ little by provider type, US survey data indicates

According to an analysis of US data, most short-term clinical outcomes in HIV care differ little by the type of clinician providing that care. However, some specific measured outcomes—retention in care and sexually transmitted disease testing rates—were higher when people living with HIV saw non-infectious disease physicians, nurse practitioners, or a combination of provider types than when they were seen only by infectious disease specialists.

About This Study

“Do HIV Care Outcomes Differ by Provider Type?” was published online on March 7, 2024, in Journal of Acquired Immune Deficiency Syndromes. The lead author is John Weiser, M.D., M.P.H., of the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention in Atlanta, Georgia.

Key Research Findings

As part of the Centers for Disease Control and Prevention’s Medical Monitoring Project, an annual cross-sectional survey, researchers evaluated a range of HIV clinical outcomes by provider type in 6,323 people in HIV care between 2019 and 2021. Participants were mostly middle-aged to older (27% of participants 45-54 years old, 40% of participants ≥ 55 years old) Black (41% of participants) and/or Latinx (24% of participants), men (75% of participants), on public health insurance (53% of participants).

The study compared outcomes of patients who saw only infectious disease physicians to patients who saw other providers: non-infectious disease physicians only, nurse practitioners only, physician assistants only, and a mix of providers that included an infectious disease physician.

Outcomes measured included: retention in care within the past 12 months; receipt of antiretroviral therapy prescription in past 12 months; antiretroviral therapy adherence in past 30 days; sustained viral suppression in past 12 months; STI testing in past 12 months; patient satisfaction with their HIV care; and level of provider trust.

The researchers found that most of these outcomes did not differ significantly by provider type, except for retention in care and recent STI testing. Both of these were more common among participants who were seen by non-infectious disease physicians, nurse practitioners, or some combination of providers.

Participants who received care from non-infectious disease physicians were more likely to be seen at a Ryan White HIV/AIDS Program-funded clinic, and to have characteristics and social determinants of health associated with poorer HIV outcomes, compared to those cared for by infectious disease physicians.

Discussion Highlights and Implications for Practice

Study limitations reported included reliance on records from participants’ usual care provider, lack of information on informal consultations between non-infectious disease professionals and HIV specialists, the possibility of information bias, the chance for residual confounding, suboptimal response rates, and the fact that some of the data were collected during the COVID-19 pandemic.

The researchers observed that the differences in retention in care and sexually transmitted infection testing may be partly due to physician specialists focusing on HIV biomarkers and medication regimens during limited time with patients, rather than on coordinating care, areas that primary care physicians and other care providers address routinely.

The authors also pointed out that, unlike those cared for by nurse practitioners, people cared for by physician assistants did not differ from infectious disease physicians in terms of care retention and sexually transmitted infections testing. They suggested that the patient-centered nursing approach to care by nurse practitioners might account for the differences, when compared to the medical model of physician assistant practice.

The authors recommended that infectious disease physicians provide more comprehensive care and that primary care physicians be included in infectious disease practices.

By Barbara Jungwirth