Objective: To evaluate the impact of the availabity of highly active antiretroviral therapies (HAART) in the context of the Drug Access Initiative (DAI) on physicians' knowledge, attitudes and practices toward HIV care in Côte d'Ivoire.
Design and methods: Cross-sectional survey using self-administered questionnaires among all consulting physicians in the six 'referral centers' of the DAI and five additional centers in charge of HIV care.
Results: Among the 123 respondents (response rate = 82.0%), 45.1% took care of more than 20 HIV-infected patients during the previous year. These physicians with the most experience in HIV care had a better knowledge than the rest of the sample about HIV disease, cotrimoxazole prophylaxis and antiretroviral treatment, and were more likely to declare that HIV-infected patients may be 'dangerous for others' (33.9 versus 17.9%; P = 0.03). Although 54.5% declared that the eligibility medical criteria for HAART 'should be the same in both developing and developed countries', only 30.9% adhered to the recently issued DAI guideline (October 1999) recommending initiation of HAART for patients with CD4 cell counts < 500 x 10(6) cells/l.
Conclusion: Physicians involved in the DAI in Côte d'Ivoire have acquired appropriate expertise and knowledge about HAART, but dissemination of information about HAART must be extended to physicians with more limited experience in HIV care. Current international efforts to adapt HIV treatment guidelines for resource-limited settings may face difficulties for reaching consensus among the African health professionals in charge.