Perspectives of HIV specialists and cardiologists on the specialty referral process for people living with HIV: a qualitative descriptive study

Charles Muiruri, Amy Corneli, Linda Cooper, Carrie Dombeck, Shamea Gray, Chris T Longenecker, Eric G Meissner, Nwora Lance Okeke, April C Pettit, Teresa Swezey, Joseph Vicini, Gerald S Bloomfield, Charles Muiruri, Amy Corneli, Linda Cooper, Carrie Dombeck, Shamea Gray, Chris T Longenecker, Eric G Meissner, Nwora Lance Okeke, April C Pettit, Teresa Swezey, Joseph Vicini, Gerald S Bloomfield

Abstract

Background: Cardiology care may be beneficial for risk factor management in people living with HIV (PLWH), yet limited information is available about the referral process from the perspectives of HIV specialists and cardiologists.

Methods: We conducted 28 qualitative interviews at academic medical centers in the United States from December 2019 to February 2020 using components of the Specialty Referral Process Framework: referral decision, entry into referral care, and care integration. We analyzed the data using applied thematic analysis.

Results: Reasons for cardiology referral most commonly included secondary prevention, uncontrolled risk factors, cardiac symptoms, and medication management. Facilitators in the referral process included ease of referral, personal relationships between HIV specialists and cardiologists, and close proximity of the clinic to the patient's home. Barriers included lack of transportation, transportation costs, insurance coverage gaps, stigma, and patient reluctance.

Conclusions: Our results will inform future studies on implementation strategies aimed at improving the specialty referral process for PLWH.

Trial registration: ClinicalTrials.gov Identifier: NCT04025125 .

Keywords: Cardiology; HIV; HIV specialists; Qualitative research; Specialty referral.

Conflict of interest statement

CTL has served on an advisory board for Esperion Therapeutics and has received research funding from Gilead Sciences. The authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Cardiology referral framework

References

    1. Hall HI, Brooks JT, Mermin J. Can the United States achieve 90–90-90? Curr Opin HIV AIDS. 2019;14(6):464–470. doi: 10.1097/COH.0000000000000578.
    1. Moore RD, Bartlett JG. Dramatic decline in the HIV-1 RNA level over calendar time in a large urban HIV practice. Clin Infect Dis. 2011;53(6):600–604. doi: 10.1093/cid/cir467.
    1. UNAIDS . 90–90–90: Treatment for all. 2020.
    1. Kochanek KD MS, X.J., Arias E. Deaths: Final Data for 2017. National VitalStatistics Reports 2019 [cited 2021 January 7]; Available from: .
    1. Smit M, Cassidy R, Cozzi-Lepri A, et al. Projections of non-communicable disease and health care costs among HIV-positive persons in Italy and the U.S.A.: a modelling study. PLoS One. 2017;12(10):1–12. doi: 10.1371/journal.pone.0186638.
    1. Freiberg MS, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013;173(8):614–622. doi: 10.1001/jamainternmed.2013.3728.
    1. Islam FM, et al. Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta-analysis. HIV Med. 2012;13(8):453–468.
    1. Burkholder GA, et al. Underutilization of aspirin for primary prevention of cardiovascular disease among HIV-infected patients. Clin Infect Dis. 2012;55(11):1550–1557. doi: 10.1093/cid/cis752.
    1. Ladapo JA, et al. Disparities in the Quality of Cardiovascular Care Between HIV-Infected Versus HIV-Uninfected Adults in the United States: A Cross-Sectional Study. J Am Heart Assoc. 2017;6(11):e007107. doi: 10.1161/JAHA.117.007107.
    1. Lichtenstein KA, et al. Provider compliance with guidelines for management of cardiovascular risk in HIV-infected patients. Prev Chronic Dis. 2013;10:E10. doi: 10.5888/pcd10.120083.
    1. Pearce D, et al. Comparison of in-hospital mortality from acute myocardial infarction in HIV sero-positive versus sero-negative individuals. Am J Cardiol. 2012;110(8):1078–1084. doi: 10.1016/j.amjcard.2012.05.045.
    1. Riestenberg RA, et al. Differences in statin utilization and lipid lowering by race, ethnicity, and HIV status in a real-world cohort of persons with human immunodeficiency virus and uninfected persons. Am Heart J. 2019;209:79–87. doi: 10.1016/j.ahj.2018.11.012.
    1. Okeke NL, et al. Cardiovascular Disease Risk Management in Persons With HIV: Does Clinician Specialty Matter? Open Forum Infect Dis. 2020;7(9):361. doi: 10.1093/ofid/ofaa361.
    1. CDC. Selected National HIV Prevention and Care Outcomes in the United States. 2019. [cited 2021 January 7]. Available from: .
    1. Feinstein MJ, et al. Characteristics, prevention, and management of cardiovascular disease in people living with HIV: a scientific statement from the American heart association. Circulation. 2019;140(2):e98–e124.
    1. Muiruri C, et al. Why Do People Living with HIV Adhere to Antiretroviral Therapy and Not Comorbid Cardiovascular Disease Medications? Patient Prefer Adherence. 2020;14:985–994. doi: 10.2147/PPA.S254882.
    1. Webel A, et al. The Impact of Perceived Cardiovascular Risk on Cardiovascular Disease Prevention Behaviors in People With and Without HIV Infection. J Acquir Immune Defic Syndr. 2020;83(5):513–521. doi: 10.1097/QAI.0000000000002290.
    1. Cioe PA, Crawford SL, Stein MD. Cardiovascular risk-factor knowledge and risk perception among HIV-infected adults. J Assoc Nurses AIDS Care. 2014;25(1):60–69. doi: 10.1016/j.jana.2013.07.006.
    1. Okeke NL, et al. Coronary artery disease risk reduction in HIV-infected persons: a comparative analysis. AIDS Care. 2016;28(4):475–482. doi: 10.1080/09540121.2015.1099602.
    1. Webel AR, et al. The influence of healthcare financing on cardiovascular disease prevention in people living with HIV. BMC Public Health. 2020;20(1):1768–1768. doi: 10.1186/s12889-020-09896-8.
    1. O'Keefe JH, Carter MD, Lavie CJ. Primary and secondary prevention of cardiovascular diseases: a practical evidence-based approach. Mayo Clin Proc. 2009;84(8):741–757. doi: 10.4065/84.8.741.
    1. Gilstrap LG, et al. Community-based primary prevention programs decrease the rate of metabolic syndrome among socioeconomically disadvantaged women. J Womens Health (Larchmt) 2013;22(4):322–329. doi: 10.1089/jwh.2012.3854.
    1. Navar AM, et al. Lipid management in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry. Am Heart J. 2017;193:84–92. doi: 10.1016/j.ahj.2017.08.005.
    1. Cheng QJ, et al. Who Provides Primary Care? An Assessment of HIV Patient and Provider Practices and Preferences. J AIDS Clin Res. 2014;5(11):366.
    1. Koganti S, et al. Management of cardiovascular conditions in a cohort of patients with HIV: experience from a joint HIV/cardiology clinic. Clin Med (Lond) 2015;15(5):442–446. doi: 10.7861/clinmedicine.15-5-442.
    1. . Pathways to Cardiovascular Disease Prevention (DCRI Central and Statistical Coordinating Center). 2019 [cited 2021 Feb 1]; Available from: .
    1. Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000;23(4):334–340. doi: 10.1002/1098-240X(200008)23:4<334::AID-NUR9>;2-G.
    1. Sofaer S. Qualitative methods: what are they and why use them? Health Serv Res. 1999;34(5 Pt 2):1101–1118.
    1. Patton MQ. Qualitative research and evaluation methods. 3. Thousand Oaks, California: Sage Publications; 2002.
    1. Mehrotra A, Forrest CB, Lin CY. Dropping the baton: specialty referrals in the United States. Milbank Q. 2011;89(1):39–68. doi: 10.1111/j.1468-0009.2011.00619.x.
    1. Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020;42(8):846–854. doi: 10.1080/0142159X.2020.1755030.
    1. Ltd., Q.I.P. NVivo qualitative data analysis software. 2018.
    1. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–357. doi: 10.1093/intqhc/mzm042.
    1. Fultz SL, et al. Differences between infectious diseases-certified physicians and general medicine-certified physicians in the level of comfort with providing primary care to patients. Clin Infect Dis. 2005;41(5):738–743. doi: 10.1086/432621.
    1. Schexnayder J, et al. Understanding constraints on integrated care for people with HIV and multimorbid cardiovascular conditions: an application of the Theoretical Domains Framework. Implement Sci Commun. 2021;2(1):17. doi: 10.1186/s43058-021-00114-z.
    1. Casper M, Kramer MR, Quick H, Schieb LJ, Vaughan AS, Greer S. Changes in the geographic patterns of heart disease mortality in the United States: 1973 to 2010. Circulation. 2016;133(12):1171–1180. doi: 10.1161/CIRCULATIONAHA.115.018663.
    1. Reif S, Safley D, Wilson E, Whetten K. HIV/AIDS in the US Deep South. Durham: Southern HIV/AIDS Strategy Initiative; 2016.
    1. Sagrestano LM, et al. Transportation vulnerability as a barrier to service utilization for HIV-positive individuals. AIDS Care. 2014;26(3):314–319. doi: 10.1080/09540121.2013.819403.
    1. IAPAC Protocols for the Integrated Management of HIV and Noncommunicable Diseases . International Association of Providers of AIDS Care. 2018.
    1. Lankowski AJ, et al. Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review. AIDS Behav. 2014;18(7):1199–1223. doi: 10.1007/s10461-014-0729-8.
    1. Smith E, Badowski ME. Telemedicine for HIV care: current status and future prospects. HIV AIDS (Auckl) 2021;13:651–656.
    1. van den Berk GEL, Leoni MC, Behrens GMN, Taljaard J, Arends JE. Improving HIV-related care through eHealth. Lancet HIV. 2020;7(1):e8–e10. doi: 10.1016/S2352-3018(19)30348-0.
    1. Stockton MA, Giger K, Nyblade L. A scoping review of the role of HIV-related stigma and discrimination in noncommunicable disease care. PLoS ONE. 2018;13(6):e0199602. doi: 10.1371/journal.pone.0199602.
    1. Ameh S, D’Ambruoso L, Gómez-Olivé FX, Kahn K, Tollman SM, Klipstein-Grobusch K. Paradox of HIV stigma in an integrated chronic disease care in rural South Africa: Viewpoints of service users and providers. PLoS ONE. 2020;15(7):e0236270. doi: 10.1371/journal.pone.0236270.
    1. Okeke NL, Chin T, Clement M, Chow SC, Hicks CB. Coronary artery disease risk reduction in HIV-infected persons: a comparative analysis. AIDS Care. 2016;28(4):475–482. doi: 10.1080/09540121.2015.1099602.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner