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Black race and depression associated with poorer adherence to HIV treatment
Michael Carter, 2012-05-08 09:40:00
African American patients have significantly poorer adherence to HIV therapy compared to other racial groups, investigators report in Journal of General Internal Medicine. Overall, black patients were 30% less likely to have optimal levels of treatment adherence than patients of other races.
The investigators also found evidence that untreated depression was associated with lower rates of adherence.
“The results of this study indicate that a significant racial disparity exists in HIV medication adherence,” write the authors. “Depressed patients who did not receive antidepressant medication not only had worse adherence than their medicated counterparts, but also had lower adherence compared to non-depressed patients.”
Significant racial disparities have been noted in several aspects of HIV infection. The incidence of new infections in the US is highest among African Americans, a group of patients which has the lowest rates of engagement with HIV care, is least likely to take antiretroviral therapy, and black patient also has the poorest survival rates.
However, there is currently little information on the relationship between race and adherence. It is also uncertain if depression leads to poorer adherence to therapy.
A team of investigators therefore studied the medical records of approximately 7000 Medicaid patients who received HIV therapy between 2003 and 2009. All the patients had at least two follow-up appointments over a twelve-month period. Adherence was assessed by checking pharmacy refill records. Patients were defined as adherent if they had sufficient medication to cover 90% of all doses.
Over two-thirds of patients were black. The “non-black” racial group included 1318 whites, 75 Hispanics and 994 patients of other races and ethnicities.
There were significant differences between the black and non-black patients. The black race group were slightly younger (mean = 41.1 vs. 41.7 years; p = 0.0055), had a higher proportion of females (55% vs. 43%; p < 0.001), had more severe HIV disease (16% vs. 12%; p < 0.001) and had a higher prevalence of depression (57% vs. 42%; p < 0.001).
African American patients were also less likely to achieve 90% adherence than non-black patients (29% vs. 39%; p < 0.001).
After adjusting for other factors potentially associated with poorer adherence, including depression, the investigators found that black patients were 30% less likely to have optimum adherence levels than individuals from other racial groups (OR = 0.70; 95% CI, 0.63-0.78).
“Black race was significantly associated with decreased odds of antiretroviral therapy adherence,” comment the authors. “These racial disparities may be attributed to findings that show black patients are more likely to postpone medical care, have less access to care, and less trust in healthcare providers than white patients.”
Surprisingly, the investigators fund that depressed patients were 15% more likely than non-depressed patients to have 90% adherence or better.
But further analysis showed that this was due to the beneficial effects of antidepressant therapy.
Depressed patients who received this treatment were almost twice as likely as non-treated depressed individuals to achieve optimum adherence (OR = 1.92; 95% CI, 1.12-3.29).
“It seems that the improvement in adherence may be attributed to the receipt of antidepressant therapy,” suggest the researchers. “This implies that depression does have the expected negative impact on antiretroviral therapy adherence if left untreated.”
They conclude: “Our results demonstrate that black patients are at a disadvantage compared to other races when it comes to antiretroviral adherence, and that these racial disparities persist independent of whether depression is also present.”
The authors believe that “disease management programs within Medicaid could be especially beneficial to disadvantaged groups by providing customized disease education and self-management strategies with sensitivity to cultural and socioeconomic differences.”
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