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Relationship of Gender, Depression, and Health Care Delivery With Antiretroviral Adherence in HIV-infected Drug Users

  1. Barbara J. Turner MD, MSEd*,
  2. Christine Laine MD, MPH,
  3. Leon Cosler PhD, RP,
  4. Walter W. Hauck PhD

Article first published online: 28 APR 2003

DOI: 10.1046/j.1525-1497.2003.20122.x

Issue

Journal of General Internal Medicine

Journal of General Internal Medicine

Volume 18, Issue 4, pages 248–257, April 2003

Additional Information

How to Cite

Turner, B. J., Laine, C., Cosler, L. and Hauck, W. W. (2003), Relationship of Gender, Depression, and Health Care Delivery With Antiretroviral Adherence in HIV-infected Drug Users. Journal of General Internal Medicine, 18: 248–257. doi: 10.1046/j.1525-1497.2003.20122.x

Author Information

  1. Received from the Division of General Internal Medicine (BJT), University of Pennsylvania School of Medicine, Philadelphia, Pa; the Division of Internal Medicine and Center for Research in Medical Education and Health Care (CL), and the Division of Clinical Pharmacology (WWH), Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pa; and New York State Department of Health (LC), Albany, NY.

*Address correspondence and requests for reprints to Dr. Turner: University of Pennsylvania, 1122 Blockley Hall/6021, 423 Guardian Dr., Philadelphia, PA 19104 (e-mail: bturner@mail.med.upenn.edu).

Publication History

  1. Issue published online: 28 APR 2003
  2. Article first published online: 28 APR 2003

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Keywords:

  • HIV infection;
  • antiretroviral therapy;
  • adherence.tw;
  • compliance;
  • mental health services

BACKGROUND: Antiretroviral adherence is worse in women than in men, and depression can influence medication adherence.

OBJECTIVE: To evaluate the relationship of gender, depression, medical care, and mental health care to adherence in HIV-infected drug users.

DESIGN: Retrospective cohort study.

SETTING: New York State Medicaid program.

PARTICIPANTS: One thousand eight hundred twenty-seven female and 3,246 male drug users on combination antiretroviral therapy for more than 2 months in 1997.

MAIN MEASURES: A pharmacy-based measure of adherence was defined as ≥95% days covered by at least 2 prescribed antiretroviral drugs. Independent variables were: depression, regular drug treatment (≥6 months), regular medical care (2+ and >35% of visits), HIV-focused care (2+ visits), psychiatric care (2+ visits), and antidepressant therapy.

RESULTS: Women were less adherent than men (18% vs 25%, respectively,P < .001) and more likely to be diagnosed with depression (34% vs 29%). In persons with depression, the adjusted odds ratio (AOR) for adherence was greater for those with psychiatric care alone (AOR 1.52; 95% confidence interval [95% CI], 1.03 to 2.26) or combined with antidepressants (AOR 1.49; 95% CI, 1.04 to 2.15). In separate models by gender in persons with depression, psychiatric care plus antidepressants had a slightly stronger association with adherence in women (AOR 1.92; 95% CI, 1.00 to 3.68) than men (AOR, 1.26; 95% CI, 0.81 to 1.98). In drug users without depression, antidepressants alone were associated with greater adherence (AOR, 1.23; 95% CI, 1.02 to 1.49) with no difference by gender. Regular drug treatment was positively associated with adherence only in men.

CONCLUSIONS: In this drug-using cohort, women had worse pharmacy-measured antiretroviral adherence than men. Mental health care was significantly associated with adherence in women, while regular drug treatment was positively associated with adherence in men.

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