Cognitive–affective depressive symptoms and substance use among Latino and non-Latino White patients in HIV care: an analysis of the CFAR network of integrated clinical systems cohort
The disparity in viral suppression rates between Latino and non-Latino White patients in HIV care appears to be narrowing, but it is unclear if depression and substance use perpetuate this disparity. We analyzed electronic medical records from the CFAR network of integrated clinical systems cohort. First observations/enrollment data collected between 2007 and 2013 were analyzed, which included survey (race/ethnicity, depression, substance use, adherence) and clinical data (viral suppression). We estimated indirect effects with a regression-based bootstrapping method. In 3129 observations, Latinos and non-Latino Whites did not differ in depression or alcohol use (ORs 1.11, 0.99, ns), but did in drug use (OR 1.13, p < .001). For all patients, depression and substance use were indirectly associated with small increases (ORs 1.02–1.66) in the odds for a detectable viral load, via worse adherence. We conclude that variables not captured in EMR systems (e.g., health literacy, structural factors) may better explain viral suppression disparities that persist.
KeywordsHIV/AIDS Latino/hispanic Mental health Substance use Viral suppression
This study and the authors were supported by Grants P30AI027763, K01MH113475, R24AI067039, R01MH102198, and K24DA037034 from the National Institutes of Health (NIH).
Compliance with ethical standards
Conflict of interest
John A. Sauceda, Nadra E. Lisha, Torsten B. Neilands, Katerina A. Christopoulos, W. Christopher Mathews, Julie H. Levison, Ann M. Dennis and Mallory O. Johnson declare that they have no conflict of interest.
The University of California, San Francisco’s Institutional Review Board approved this study.
Human and animal rights and Informed consent
All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all individual participants included in the study.
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