Prevention of Pneumocystis carinii pneumonia: Who are we missing?

Objective: To obtain population-based information on the characteristics of persons who were not receiving chemoprophylaxis against Pneumocystis carinii pneumonia (PCP) by examining the use of primary and secondary PCP prophylaxis among San Francisco residents whose AIDS-defining opportunistic illness was PCP in 1993. Design: Retrospective medical record review. Setting: Medical charts were obtained From San Francisco hospitals and outpatient facilities at which AIDS patients received their initial AIDS diagnosis. Participants: San Francisco residents whose AIDS-defining opportunistic illness was PCP in 1993. Main outcome measures: Use of primary and secondary PCP prophylaxis. Results: Of the 326 eligible patients, 35% received primary PCP prophylaxis. Nonwhites were significantly less likely to have received primary PCP prophylaxis than white patients [22 versus 40%, respectively; odds ratio (OR), 0.49195% confidence intervals (CI), 0.28-0.87]. Uninsured individuals were also less likely to have received primary PCP prophylaxis than those with insurance (18 versus 41%, OR, 0.35; 95% Cl, 0.17-0.73). The sociodemographic characteristics of patients who did and did not receive secondary PCP prophylaxis did not differ significantly. The most frequently cited reasons for not receiving primary PCP prophylaxis were that patients were unaware of their infection with HIV or were not receiving regular medical care. Conclusions: Barriers to receipt of PCP prophylaxis exist and are resulting in cases of preventable disease and unnecessary medical costs. Interventions to increase counseling, testing, and referral to medical care for pet-sons at high risk for HIV infection are needed.