Primary Care Provider Cultural Competence and Racial Disparities in HIV Care and Outcomes
ABSTRACT BACKGROUND: Health professional organizations have advocated for increasing the "cultural competence" (CC) of healthcare providers, to reduce racial and ethnic disparities in patient care. It is unclear whether provider CC is associated with more equitable care. OBJECTIVE: To evaluate whether provider CC is associated with quality of care and outcomes for patients with HIV/AIDS. DESIGN AND PARTICIPANTS: Survey of 45 providers and 437 patients at four urban HIV clinics in the U.S. MAIN MEASURES: Providers' self-rated CC was measured using a novel, 20-item instrument. Outcome measures included patients' receipt of antiretroviral (ARV) therapy, self-efficacy in managing medication regimens, complete 3-day ARV adherence, and viral suppression. KEY RESULTS: Providers' mean age was 44 years; 56 % were women, and 64 % were white. Patients' mean age was 45; 67 % were men, and 77 % were nonwhite. Minority patients whose providers scored in the middle or highest third on self-rated CC were more likely than those with providers in the lowest third to be on ARVs, have high self-efficacy, and report complete ARV adherence. Racial disparities were observed in receipt of ARVs (adjusted OR, 95 % CI for white vs. nonwhite: 6.21, 1.50-25.7), self-efficacy (3.77, 1.24-11.4), and viral suppression (13.0, 3.43-49.0) among patients of low CC providers, but not among patients of moderate and high CC providers (receipt of ARVs: 0.71, 0.32-1.61; self-efficacy: 1.14, 0.59-2.22; viral suppression: 1.20, 0.60-2.42). CONCLUSIONS: Provider CC was associated with the quality and equity of HIV care. These findings suggest that enhancing provider CC may reduce racial disparities in healthcare quality and outcomes.
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ABSTRACT: Suboptimal adherence to antiretroviral therapy (ART) significantly contributes to a viral breakthrough leading to HIV resistance to treatment. This resistance, in a person living with HIV (PLHIV), may cause the transmission of resistant viral strains to their partners, a major concern for public health. Difficulties in adherence treatment raise an ethical debate: should ART be prescribed for PLWHV who may use them incorrectly? From an interdisciplinary analysis based on the ethics of responsibility framework, one can argue that adherence in the treatment of PLHIV does not solely rely on the individual but also on interpersonal and collective responsibility. Thus, according to philosophers, to assist the poor and the sick is an ethical responsibility. Second, medical ethics states that the foundation of professional practice is based on the obligation to care and treat patients. Third, medical issues associated with the prediction of adherence show that physicians do not have the adequate skills and tools to evaluate and predict it. Interventions based on predictive models and change of non-adherent behaviors seems to predominate in the medical field, although they appear less effective than models of psychosocial theories. Finally, in legal terms, the refusal to prescribe violates rights and freedoms of individuals. Thus, barriers concerning adherence are involved at different levels of responsibility. It would thus be unethical to refuse to prescribe ART to PLHIV under the pretext of non-adherence.Éthique & Santé 01/2013; DOI:10.1016/j.etiqe.2013.11.001
- Journal of General Internal Medicine 02/2013; 28(5). DOI:10.1007/s11606-013-2363-y · 3.42 Impact Factor
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ABSTRACT: Achieving trainee diversity in science, technology, engineering, and mathematics is rapidly becoming a challenge faced by many nations. Success in this area ensures the availability of a workforce capable of engaging in scientific practices that will promote increased production capacity and creativity and will preserve global scientific competitiveness. The near-term vision of achieving this goal is within reach and will capitalize on the growing numbers of underrepresented minority groups in the population. Although many nations have had remarkable histories as leaders in science and technology, few have simultaneously struggled with the challenge of meeting the educational and training needs of underrepresented groups. In this article, we share strategies for building the agency of the scientific community to achieve greater diversity by highlighting four key action areas: (1) aligning institutional culture and climate; (2) building interinstitutional partnerships; (3) building and sustaining critical mass; and (4) ensuring, rewarding, and maximizing faculty involvement.BioScience 07/2014; 64(7):612-618. DOI:10.1093/biosci/biu076 · 5.44 Impact Factor