Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users.

Abstract

Antiretroviral adherence is worse in women than in men, and depression can influence medication adherence. To evaluate the relationship of gender, depression, medical care, and mental health care to adherence in HIV-infected drug users. Retrospective cohort study. New York State Medicaid program. One thousand eight hundred twenty-seven female and 3,246 male drug users on combination antiretroviral therapy for more than 2 months in 1997. A pharmacy-based measure of adherence was defined as > or =95% days covered by at least 2 prescribed antiretroviral drugs. Independent variables were: depression, regular drug treatment (> or =6 months), regular medical care (2+ and >35% of visits), HIV-focused care (2+ visits), psychiatric care (2+ visits), and antidepressant therapy. 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. 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.