Disparities in Viral Suppression and Medication Adherence among Women in the USA, 2011–2016

  • Angelica GeterEmail author
  • Madeline Y. Sutton
  • Carl Armon
  • Kate Buchacz
  • for the HIV Outpatient Study Investigators
Original Paper


We assessed disparities in viral suppression (VS) and antiretroviral therapy (ART) adherence among women of the HIV Outpatient Study to inform HIV treatment strategies. We used adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) to assess VS by race/ethnicity and generalized estimating equations to investigate factors associated with not achieving VS and ART non-adherence. Among 426 women (median age = 46 years), at baseline, VS was less prevalent among black women (63%) compared with Hispanic women/Latinas (73%) and white women (78%). In the multivariable analysis, factors significantly associated with not achieving VS included the following social and behavioral determinants of care: using public insurance (aPR = 1.69, CI 1.01–2.82, p = 0.044) compared to using private insurance, seeking care in a public clinic (aPR = 1.60, CI 1.03–2.50, p = 0.037) compared to seeking care in a private clinic, and ART non-adherence (aPR = 2.79, CI 1.81–4.29), p < 0.001). Although race was not a significant factor in not achieving VS, race was associated with ART non-adherence; black women were more likely to miss a dose of ART medication (aPR = 2.07, CI 1.19–3.60, p = 0.010) when compared to white women and Hispanic women/Latinas. Interventions and resources disseminated to address social barriers to care and improve VS and ART adherence among HIV-positive women, particularly black women, are warranted.


Viral suppression Medication adherence HIV/AIDS African American Women Disparities 



The authors contributed equally to this work, based on the following criteria: (1) substantial contributions to the conception or design of the work (A.G and M.S), (2) the acquisition, analysis, or interpretation of data for the work (A.G., M.S. and C.A.), (3) drafting the work or revising it critically for important intellectual content (A.G., M.S. C.A., and K.B), (4) final approval of the version to be published (A.G., M.S. C.A., and K.B), and (5) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (A.G., M.S. C.A., and K.B). We also wish to acknowledge the contributions of the HOPS patients, as well as the HOPS Investigators: Kate Buchacz, Marcus D. Durham, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA; Harlen Hays, Rachel Hart, Thilakavathy Subramanian, Carl Armon, Stacey Purinton, Dana Franklin, Cheryl Akridge, Nabil Rayeed, Linda Battalora Cerner Corporation, Kansas City, MO; Frank J. Palella, Saira Jahangir, Conor Daniel Flaherty, Patricia Bustamante, Feinberg School of Medicine, Northwestern University, Chicago, IL; John Hammer, Kenneth S. Greenberg, Barbara Widick, Rosa Franklin, Rose Medical Center, Denver, CO; Bienvenido G. Yangco, Kalliope Chagaris, Infectious Disease Research Institute, Tampa, FL; Douglas J. Ward, Troy Thomas, Cheryl Stewart, Dupont Circle Physicians Group, Washington, DC; Jack Fuhrer, Linda Ording-Bauer, Rita Kelly, Jane Esteves, State University of New York (SUNY), Stony Brook, NY; Ellen M. Tedaldi, Ramona A. Christian, Faye Ruley, Dania Beadle, Princess Davenport, Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Richard M. Novak, Andrea Wendrow, University of Illinois at Chicago, Chicago, IL; Benjamin Young, Mia Scott, Barbara Widick, Billie Thomas, APEX Family Medicine, Denver, CO.


The authors have no financial conflicts to report.


The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention


This work was supported by the CDC (Contract Numbers 200-2001-00133, 200-2006-18797 and 200-2011-41872).

Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2017; vol. 29. Published November 2018. Accessed 19 Dec 2018.
  2. 2.
    Centers for Disease Control and Prevention. HIV Surveillance—Epidemiology of HIV Infection (through 2017). Accessed 19 Dec 2018.
  3. 3.
    Centers for Disease Control and Prevention. HIV surveillance in women, 2017. Accessed 19 Dec 2018.
  4. 4.
    Office of National AIDS Policy. National HIV/AIDS Strategy for the United States: Updated to 2020. Washington, DC: Office of National AIDS Policy. Accessed 2 Apr 2018.
  5. 5.
    Geter A, Sutton M, McCree DH. Social and structural determinants of HIV treatment and care among black women living with HIV infection: a systematic review: 2005-2016. AIDS Care. 2018;30(4):409–16. Scholar
  6. 6.
    Nwangwu-Ike N, Hernandez AL, An Q, Huang T, Hall HI. The epidemiology of human immunodeficiency virus infection and care among adult and adolescent females in the United States, 2008–2012. Womens Health Issues. 2015;25(6):711–9.CrossRefGoogle Scholar
  7. 7.
    Giordano TP, Gifford AL, White AC Jr, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.CrossRefGoogle Scholar
  8. 8.
    Mugavero MJ, Davila JA, Nevin CR, Giordano TP. From access to engagement: measuring retention in outpatient HIV clinical care. AIDS Patient Care STDS. 2010;24(10):607–13.CrossRefGoogle Scholar
  9. 9.
    Bradley H, Mattson CL, Beer L, et al. Increased antiretroviral therapy prescription and HIV viral suppression among persons receiving clinical care for HIV infection. AIDS. 2016;30(13):2117–24. Scholar
  10. 10.
    Geter A, Sutton MY, Armon C, et al. Trends of racial and ethnic disparities in virologic suppression among women in the HIV Outpatient Study, USA, 2010–2015. PLoS ONE. 2018;13(3):e0194413.CrossRefGoogle Scholar
  11. 11.
    Tedaldi EM, Baker RK, Moorman AC, et al. Influence of coinfection with hepatitis C virus on morbidity and mortality due to human immunodeficiency virus infection in the era of highly active antiretroviral therapy. Clin Infect Dis. 2003;36(3):363–7.CrossRefGoogle Scholar
  12. 12.
    Marzolini C, Elzi L, Gibbons S, et al. Prevalence of comedications and effect of potential drug-drug interactions in the Swiss HIV Cohort Study. Antivir Ther. 2010;15(3):413.CrossRefGoogle Scholar
  13. 13.
    Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3:17. Scholar
  14. 14.
    Palella FJ Jr, Baker RK, Buchacz K, et al. Increased mortality among publicly insured participants in the HIV Outpatient Study despite HAART treatment. AIDS. 2011;25(15):1865–76. Scholar
  15. 15.
    Centers for Disease Control and Prevention. Social determinants of health and selected HIV care outcomes among adults with diagnosed HIV infection in 32 states and the District of Columbia, 2014. HIV Surveillance Supplemental Report 2016;21(No. 7). Published December 2016. Accessed 1 Nov 2018.
  16. 16.
    Baker JL, Rodgers CR, Davis ZM, Gracely E, Bowleg L. Results from a secondary data analysis regarding satisfaction with health care among African American women living with HIV/AIDS. J Obstet Gynecol Neonatal Nurs. 2014;43(5):664–76.CrossRefGoogle Scholar
  17. 17.
    Halkitis PN, Kuppart SA, Mukherjee P. Longitudinal associations between case management and supportive services use among black and Latina HIV-positive women in New York City. J Womens Health. 2010;19(1):99–108.CrossRefGoogle Scholar
  18. 18.
    Vyavaharkar MV, Moneyham L, Corwin S. Health care utilization: the experiences of rural HIV-positive African American women. J Health Care Poor Underserv. 2008;19(1):294–306.CrossRefGoogle Scholar
  19. 19.
    Wyatt GE, Carmona JV, Loeb TB, Williams JK. HIV-positive black women with histories of childhood sexual abuse: patterns of substance use and barriers to health care. J Health Care Poor Underserv. 2005;16(4 Suppl B):9–23.CrossRefGoogle Scholar
  20. 20.
    Hanna DB, Buchacz K, Gebo KA, et al. Trends and disparities in antiretroviral therapy initiation and virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001–2009. Clin Infect Dis. 2013;56(8):1174–82. Scholar
  21. 21.
    Novak RM, Hart RL, Chmiel JS, et al. Disparities in initiation of combination antiretroviral treatment and in virologic suppression among patients in the HIV Outpatient Study, 2000–2013. J Acquir Immune Defic Syndr. 2013;70(1):23–32.CrossRefGoogle Scholar
  22. 22.
    Milhausen R, Sale J, Wingood G. Validation of a partner sexual communication scale for use in HIV/AIDS prevention interventions. J HIV/AIDS Prev Child Youth. 2007;8(1):11–33. Scholar
  23. 23.
    Centers for Disease Control and Prevention. Behavioral and clinical characteristics of persons receiving medical care for HIV infection—Medical Monitoring Project, United States, 2014 Cycle (June 2014–May 2015). HIV Surveillance Special Report 17. Accessed 28 Mar 2018.
  24. 24.
    Beer L, Mattson CL, Bradley H, Skarbinski J, Medical Monitoring Project. Understanding cross-sectional racial, ethnic, and gender disparities in antiretroviral use and viral suppression among HIV patients in the United States. Medicine. 2016;95(13):e3171. Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.Division of HIV/AIDS PreventionDHAP/NCHHSTP/CDC, Centers for Disease Control and PreventionAtlantaUSA
  2. 2.Cerner CorporationKansas CityUSA

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