In the current study, researchers set out to describe the system-wide uptake of three HIV protease inhibitors - atazanavir, darunavir, and tipranavir - in the Veterans Healthcare Administration (VHA).
The retrospective cohort study used VHA HIV Clinical Case Registry data to examine VHA uptake of the three target antiretrovirals and lopinavir/ritonavir in each complete 90-day quarter since approval to December 2007. Factors assessed included the number of new prescriptions, the number of providers and facilities prescribing the target drugs, type of provider, type of clinic, size of facility and location with four regions of the United States.
A total of 6,551 veterans living with HIV received the target antiretrovirals. In general, uptake was highest in the first year after Food and Drug Administration approval, then declined slightly and plateaued. Comparison of uptake patterns of new antiretrovirals to use of all antiretrovirals showed early adoption of new ones tended to occur in the West. Among prescribers of all antiretrovirals, a small percentage were responsible for new prescriptions for the target drugs - particularly for darunavir and tipranavir. At almost 50 percent of VHA facilities, providers were prescribing these drugs within the first year.
"Uptake of new antiretrovirals in the VHA generally reflected overall prescribing of all antiretrovirals, suggesting a lack of VHA impediments to new antiretrovirals in the health care system," the authors concluded. "Some regional variation in uptake among the targeted antiretrovirals occurred over time but tended to resolve after the first several months. Providers responsible for early prescribing of the target medications were limited to a fraction of providers who tended to be physicians who practiced in infectious disease (ID) clinics at medium-sized facilities."
2/16/10
USA: Trends in Uptake of Recently Approved Antiretrovirals within a National Healthcare System
Source: HIV Medicine Vol. 11; No. 3: P. 209-215 (03..10):: P.S. Belperio; L.A. Mole; D.B. Boothroyd; L.I. Backus; Courtesy of the CDC National Center for HIV, STD, and TB Prevention