Disparities in Viral Suppression and Medication Adherence among Women in the USA, 2011–2016
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.
KeywordsViral 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.
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 was obtained from all individual participants included in the study.
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