Background: African Americans are disproportionately affected by HIV/AIDS. They have the highest rates of HIV-infection incidence, prevalence, and AIDS-related mortality. A high level of life-long adherence to antiretroviral regimens is essential for maximizing viral load suppression, preventing HIV transmission, and prolonging survival time. Yet adherence levels remain suboptimal. In addition, concurrent experiences such as pregnancy and depression may further diminish adherence levels.
Objectives: The main objective of this study was to assess racial differences in HIV treatment adherence among low-income populations, including more vulnerable populations such as in depressive patients and postpartum women. Subsequently, this study also examined the association between adherence and disease progression, hospitalization risk, and other healthcare utilization outcomes in the overall low-income HIV-infected population. Lastly, this study assessed the association between race and depression during pregnancy and the postpartum period among low-income women with HIV-infection.
Methods: Retrospective cohort study using data from multi-state Medicaid administrative claims database of HIV-infected patients between 2003 and 2007. Multivariate regression analyses were used to study the objectives.
Results: Black race was significantly associated with decreased odds of being adherent to antiretroviral therapy, increased hospitalization risk, increased number of ER visits, and higher total HIV-related healthcare costs. Further, even accounting for racial differences, adherent patients had decreased odds of developing AIDS and lower hospitalization risk. Within a population of depressive patients, black race was also negatively associated with adherence. No racial difference in adherence was found among postpartum women. However, black women had lower odds of experiencing perinatal depression. Throughout the study, women consistently showed significantly lower rates of adherence compared to men.
Conclusions: This study found that racial disparities in adherence exist in both general and depressive low-income populations with HIV-infection. Increased vigilance for depressive symptoms is warranted by healthcare providers, especially in black women infected with HIV.