BACKGROUND: Racial disparities exist in many aspects of HIV/AIDS. Comorbid depression adds to the complexity of disease management. However, prior research does not clearly show an association between race and antiretroviral therapy (ART) adherence, or depression and adherence. It is also not known whether the co-existence of depression modifies any racial differences that may exist. OBJECTIVE: To examine racial differences in ART adherence and whether the presence of comorbid depression moderates these differences among Medicaid-enrolled HIV-infected patients. DESIGN: Retrospective cohort study. SETTING: Multi-state Medicaid database (Thomson Reuters MarketScan®). PARTICIPANTS: Data for 7,034 HIV-infected patients with at least two months of antiretroviral drug claims between 2003 and 2007 were assessed. MAIN MEASURES: Antiretroviral therapy adherence (90 % days covered) were measured for a 12-month period. The main independent variables of interest were race and depression. Other covariates included patient variables, clinical variables (comorbidity and disease severity), and therapy-related variables. KEY RESULTS: In this study sample, over 66 % of patients were of black race, and almost 50 % experienced depression during the study period. A significantly higher portion of non-black patients were able to achieve optimal adherence (≥90 %) compared to black patients (38.6 % vs. 28.7 %, p < 0.001). In fact, black patients had nearly 30 % decreased odds of being optimally adherent to antiretroviral drugs compared to non-black patients (OR = 0.70, 95 % CI: 0.63-0.78), and was unchanged regard less of whether the patient had depression. Antidepressant treatment nearly doubled the odds of optimal ART adherence among patients with depression (OR = 1.92, 95 % CI: 1.12-3.29). CONCLUSIONS: Black race was significantly associated with worse ART adherence, which was not modified by the presence of depression. Under-diagnosis and under-treatment of depression may hinder ART adherence among HIV-infected patients of all races.
BACKGROUND: Racial disparities exist in many aspects of HIV/AIDS. Comorbid depression adds to the complexity of disease management. However, prior research does not clearly show an association between race and antiretroviral therapy (ART) adherence, or depression and adherence. It is also not known whether the co-existence of depression modifies any racial differences that may exist. OBJECTIVE: To examine racial differences in ART adherence and whether the presence of comorbid depression moderates these differences among Medicaid-enrolled HIV-infectedpatients. DESIGN: Retrospective cohort study. SETTING: Multi-state Medicaid database (Thomson Reuters MarketScan®). PARTICIPANTS: Data for 7,034 HIV-infectedpatients with at least two months of antiretroviral drug claims between 2003 and 2007 were assessed. MAIN MEASURES: Antiretroviral therapy adherence (90 % days covered) were measured for a 12-month period. The main independent variables of interest were race and depression. Other covariates included patient variables, clinical variables (comorbidity and disease severity), and therapy-related variables. KEY RESULTS: In this study sample, over 66 % of patients were of black race, and almost 50 % experienced depression during the study period. A significantly higher portion of non-black patients were able to achieve optimal adherence (≥90 %) compared to black patients (38.6 % vs. 28.7 %, p < 0.001). In fact, black patients had nearly 30 % decreased odds of being optimally adherent to antiretroviral drugs compared to non-black patients (OR = 0.70, 95 % CI: 0.63-0.78), and was unchanged regard less of whether the patient had depression. Antidepressant treatment nearly doubled the odds of optimal ART adherence among patients with depression (OR = 1.92, 95 % CI: 1.12-3.29). CONCLUSIONS: Black race was significantly associated with worse ART adherence, which was not modified by the presence of depression. Under-diagnosis and under-treatment of depression may hinder ART adherence among HIV-infectedpatients of all races.
Authors: Bruce R Schackman; Heather J Ribaudo; Amy Krambrink; Valery Hughes; Daniel R Kuritzkes; Roy M Gulick Journal: J Acquir Immune Defic Syndr Date: 2007-12-15 Impact factor: 3.731
Authors: Michael Mugavero; Jan Ostermann; Kathryn Whetten; Jane Leserman; Marvin Swartz; Dalene Stangl; Nathan Thielman Journal: AIDS Patient Care STDS Date: 2006-06 Impact factor: 5.078
Authors: Xiuhong Li; Joseph B Margolick; Craig S Conover; Sheila Badri; Sharon A Riddler; Mallory D Witt; Lisa P Jacobson Journal: J Acquir Immune Defic Syndr Date: 2005-03-01 Impact factor: 3.731
Authors: Sheri D Weiser; Elise D Riley; Kathleen Ragland; Gwendolyn Hammer; Richard Clark; David R Bangsberg Journal: J Gen Intern Med Date: 2006-01 Impact factor: 5.128
Authors: Kelly A Gebo; John A Fleishman; Richard Conviser; Erin D Reilly; P Todd Korthuis; Richard D Moore; James Hellinger; Philip Keiser; Haya R Rubin; Lawrence Crane; Fred J Hellinger; W Christopher Mathews Journal: J Acquir Immune Defic Syndr Date: 2005-01-01 Impact factor: 3.731
Authors: Angela D Thrasher; Jo Anne L Earp; Carol E Golin; Catherine R Zimmer Journal: J Acquir Immune Defic Syndr Date: 2008-09-01 Impact factor: 3.731
Authors: H Irene Hall; Ruiguang Song; Philip Rhodes; Joseph Prejean; Qian An; Lisa M Lee; John Karon; Ron Brookmeyer; Edward H Kaplan; Matthew T McKenna; Robert S Janssen Journal: JAMA Date: 2008-08-06 Impact factor: 56.272
Authors: Michael Alan Horberg; Michael Jonah Silverberg; Leo Bartemeier Hurley; William James Towner; Daniel Benjamin Klein; Susan Bersoff-Matcha; Winkler Gabriel Weinberg; Diana Antoniskis; Miguel Mogyoros; Wayne Thomas Dodge; Robert Dobrinich; Charles Price Quesenberry; Drew Anthony Kovach Journal: J Acquir Immune Defic Syndr Date: 2008-03-01 Impact factor: 3.731
Authors: Bora Youn; Theresa I Shireman; Yoojin Lee; Omar Galárraga; Aadia I Rana; Amy C Justice; Ira B Wilson Journal: AIDS Date: 2017-07-31 Impact factor: 4.177
Authors: Frederick M Hecht; Judith T Moskowitz; Patricia Moran; Elissa S Epel; Peter Bacchetti; Michael Acree; Margaret E Kemeny; Wendy Berry Mendes; Larissa G Duncan; Helen Weng; Jay A Levy; Steven G Deeks; Susan Folkman Journal: Brain Behav Immun Date: 2018-05-26 Impact factor: 7.217
Authors: Maria L Ekstrand; Elsa Heylen; Matilda Pereira; Jacob D'Souza; Shoba Nair; Amanda Mazur; Ranjani Shamsundar; B N Ravi Kumar; Sara Chandy Journal: AIDS Behav Date: 2020-07