Zoe M Weinstein1, Tracy A Battaglia2, Amy S Baranoski3. 1. 1 Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine , Boston, Massachusetts. 2. 2 Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine , Boston, Massachusetts. 3. 3 Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine , Philadelphia, Pennsylvania.
Abstract
BACKGROUND: Both HIV-infected women and minority women have historically lower rates of screening mammography. The objective of this study was to identify factors related to adherence to routine screening mammography in a diverse inner-city cohort of HIV-infected women, to inform future work on targeted interventions to address disparities. MATERIALS AND METHODS: This retrospective cohort study reviewed the electronic medical record of HIV-infected women aged 40 and older engaged in care between October 1, 2003 and March 31, 2008 at a large urban safety-net HIV clinic. Analyses included chi square testing and multivariate logistic regression to assess for patient-specific factors associated with adherence to breast cancer screening, defined as obtaining a screening mammogram within 2 years of engaging in care. RESULTS: The 292 women were a racially diverse group, with 70% black, 11% Hispanic, and 42% foreign born. There was suboptimal HIV control, with only 33% having an undetectable viral load (VL). One hundred forty-six (50%) were adherent to screening mammography. In multivariate analysis, women who were foreign born (OR 2.65 [CI 1.52-4.64]) had not completed high school (OR 1.77 [CI 1.06-2.95]) or had an undetectable VL (OR 2.51 [CI 1.44-4.40]) had increased odds of obtaining a mammogram. CONCLUSIONS: Among a racially diverse urban population of HIV-infected women engaged in care, only half had a mammogram. Foreign-born women had higher odds of undergoing mammography, suggesting that nativity status and social determinants of health are under-recognized drivers of adherence in this population. Future programs targeting screening must be mindful of the multiple predictors of adherence.
BACKGROUND: Both HIV-infectedwomen and minority women have historically lower rates of screening mammography. The objective of this study was to identify factors related to adherence to routine screening mammography in a diverse inner-city cohort of HIV-infectedwomen, to inform future work on targeted interventions to address disparities. MATERIALS AND METHODS: This retrospective cohort study reviewed the electronic medical record of HIV-infectedwomen aged 40 and older engaged in care between October 1, 2003 and March 31, 2008 at a large urban safety-net HIV clinic. Analyses included chi square testing and multivariate logistic regression to assess for patient-specific factors associated with adherence to breast cancer screening, defined as obtaining a screening mammogram within 2 years of engaging in care. RESULTS: The 292 women were a racially diverse group, with 70% black, 11% Hispanic, and 42% foreign born. There was suboptimal HIV control, with only 33% having an undetectable viral load (VL). One hundred forty-six (50%) were adherent to screening mammography. In multivariate analysis, women who were foreign born (OR 2.65 [CI 1.52-4.64]) had not completed high school (OR 1.77 [CI 1.06-2.95]) or had an undetectable VL (OR 2.51 [CI 1.44-4.40]) had increased odds of obtaining a mammogram. CONCLUSIONS: Among a racially diverse urban population of HIV-infectedwomen engaged in care, only half had a mammogram. Foreign-born women had higher odds of undergoing mammography, suggesting that nativity status and social determinants of health are under-recognized drivers of adherence in this population. Future programs targeting screening must be mindful of the multiple predictors of adherence.
Authors: Susan Preston-Martin; Lynn M Kirstein; Janice M Pogoda; Barbara Rimer; Sandra Melnick; Lena Masri-Lavine; Sylvia Silver; Nancy Hessol; Audrey L French; Joseph Feldman; Henry S Sacks; Maureen Deely; Alexandra M Levine Journal: Prev Med Date: 2002-03 Impact factor: 4.018
Authors: Amy S Baranoski; C Robert Horsburgh; L Adrienne Cupples; Ann Aschengrau; Elizabeth A Stier Journal: J Womens Health (Larchmt) Date: 2011-08-31 Impact factor: 2.681
Authors: Basil F El-Rayes; Kambeez Berenji; Paula Schuman; Philip A Philip; Kambeez Barenji Journal: Breast Cancer Res Treat Date: 2002-11 Impact factor: 4.872
Authors: Melissa L McPheeters; Sunil Kripalani; Neeraja B Peterson; Rachel T Idowu; Rebecca N Jerome; Shannon A Potter; Jeffrey C Andrews Journal: Evid Rep Technol Assess (Full Rep) Date: 2012-08
Authors: Claire E Kendall; Sharon Walmsley; Cindy Lau; Nathaniel Jembere; Ann N Burchell; Mona Loutfy; Janet Raboud; Ron Rosenes; Sean B Rourke; Tony Antoniou Journal: CMAJ Open Date: 2017-08-30