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

The current study investigated the role of racial concordance between patients and medical providers on the timing of receipt of protease inhibitor therapy. Data was obtained from the HIV Cost and Services Utilization Study (HCSUS), a nationally representative study of HIV-positive adults. The sample used in the current study consisted of 1,241 people who completed a baseline survey and linked data from 287 providers. Participants provided information about the antiretroviral medications they were using at baseline and at follow-up as well as when they began to use protease inhibitors. Four groups were compared: African-American patients with either black (6% of the sample) or white providers (32%) and white patients with black (less than 1% or white providers (61%). Parametric time-to-event models were used to measure how racial concordance related to when patients first used protease inhibitors. Black patients used protease inhibitors 439 days after the FDA approved them as compared to 277 days for white patients. Controlling for patient factors resulted in a wait of 440 days for black patients as compared to 348 days for white patients. Taking into account all patient covariates, no statistically significant differences were found between black patients with black providers (342 days) and white patients with white providers (353 days) in time to first protease inhibitor use. There was a significant difference between first time protease inhibitor use for black patients with white providers and white patients with white providers (461 vs. 353 days; p = .002). This difference was not accounted for when other factors, such as provider characteristics, were controlled for in the analysis. Trying to understand why these differences exist should help to reduce health disparities between African Americans and whites.

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