Does Racial Concordance Between HIV-positive Patients and Their Physicians Affect the Time to Receipt of Protease Inhibitors?

Published in: Journal of General Internal Medicine, v. 19, no. 11, Nov. 2004, p. 1146-1153

Posted on RAND.org on January 01, 2004

by William D. King, Mitchell D. Wong, Martin F. Shapiro, Bruce E. Landon, William Cunningham

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BACKGROUND: Compared to whites, African Americans have been found to have greater morbidity and mortality from HIV, partly due to their lower use of effective antiretroviral therapy. Why racial disparities in antiretroviral use exist is not completely understood. The authors examined whether racial concordance (patients and providers having the same race) affects the time of receipt of protease inhibitors. METHODS: They analyzed data from a prospective, cohort study of a national probability sample of 1,241 adults receiving HIV care with linked data from 287 providers. The authors examined the association between patient-provider racial concordance and time from when the Food and Drug Administration approved the first protease inhibitor to the time when patients first received a protease inhibitor. RESULTS: In our unadjusted model, white patients received protease inhibitors much earlier than African-American patients (median 277 days compared to 439 days; P < .0001). Adjusting for patient characteristics only, African-American patients with white providers received protease inhibitors significantly later than African-American patients with African-American providers (median 461 days vs. 342 days respectively; P < .001) and white patients with white providers (median 461 vs. 353 days respectively; P = .002). In this model, no difference was found between African-American patients with African-American providers and white patients with white providers (342 vs. 353 days respectively; P > .20). Adjusting for patients' trust in providers, as well as other patient and provider characteristics in subsequent models, did not account for these differences. CONCLUSION: Patient-provider racial concordance was associated with time to receipt of protease inhibitor therapy for persons with HIV. Racial concordance should be addressed in programs, policies, and future racial and ethnic health disparity research.

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