Disparities in Viral Suppression and Medication Adherence among Women in the USA, 2011–2016

• Published in: AIDS and behavior Vol. 23; no. 11; pp. 3015 - 3023
• Main Authors: Geter, Angelica, Sutton, Madeline Y., Armon, Carl, Buchacz, Kate
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2019; Springer Nature B.V
• Subjects: Adhesion; Adult; African Americans; African Americans - statistics & numerical data; Ambulatory Care Facilities; Anti-HIV Agents - therapeutic use; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Black people; Confidence intervals; Continuity of Patient Care - statistics & numerical data; Ethnic Groups; Ethnicity; European Continental Ancestry Group - statistics & numerical data; Female; Health Care Surveys; Health Psychology; Health Status Disparities; Healthcare Disparities - ethnology; Hispanic Americans; Hispanic Americans - statistics & numerical data; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - ethnology; HIV Infections - virology; Human immunodeficiency virus; Humans; Infectious Diseases; Insurance; Latin American cultural groups; Medication adherence; Medication Adherence - ethnology; Medication Adherence - statistics & numerical data; Medicine; Medicine & Public Health; Middle Aged; Minority & ethnic groups; Original Paper; Outpatients; Patient compliance; Prescription drugs; Prevalence; Public Health; Race; Racial differences; Treatment compliance; United States - epidemiology; Viral Load - drug effects; Viral Load - statistics & numerical data; Women; Womens health; Young Adult; United States; United States > US; Medication adherence; HIV/AIDS; Women; Disparities; Viral suppression; African American
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-019-02494-9

We assessed disparities in viral suppression (VS) and antiretroviral therapy (ART) adherence among women of the HIV Outpatient Study to inform HIV treatment strategies. We used adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) to assess VS by race/ethnicity and generalized estimating equations to investigate factors associated with not achieving VS and ART non-adherence. Among 426 women (median age = 46 years), at baseline, VS was less prevalent among black women (63%) compared with Hispanic women/Latinas (73%) and white women (78%). In the multivariable analysis, factors significantly associated with not achieving VS included the following social and behavioral determinants of care: using public insurance (aPR = 1.69, CI 1.01–2.82, p = 0.044) compared to using private insurance, seeking care in a public clinic (aPR = 1.60, CI 1.03–2.50, p = 0.037) compared to seeking care in a private clinic, and ART non-adherence (aPR = 2.79, CI 1.81–4.29), p < 0.001). Although race was not a significant factor in not achieving VS, race was associated with ART non-adherence; black women were more likely to miss a dose of ART medication (aPR = 2.07, CI 1.19–3.60, p = 0.010) when compared to white women and Hispanic women/Latinas. Interventions and resources disseminated to address social barriers to care and improve VS and ART adherence among HIV-positive women, particularly black women, are warranted.