Racial/Ethnic Disparities in ART Adherence in the United States: Findings From the MACH14 Study
Published Date:Aug 15 2012
Source:J Acquir Immune Defic Syndr. 2012; 60(5):466-472.
Pubmed Central ID:PMC3607367
Funding:AI069419/AI/NIAID NIH HHS/United States
AI38858/AI/NIAID NIH HHS/United States
CC02-SD-003/CC/ODCDC CDC HHS/United States
CC99-SD003/CC/ODCDC CDC HHS/United States
K02DA017277/DA/NIDA NIH HHS/United States
K23MH01862/MH/NIMH NIH HHS/United States
K24 MH092242/MH/NIMH NIH HHS/United States
K24 MH093243/MH/NIMH NIH HHS/United States
P01MH49548/MH/NIMH NIH HHS/United States
P30 AI027757/AI/NIAID NIH HHS/United States
P30 AI050410/AI/NIAID NIH HHS/United States
R01 MH054907/MH/NIMH NIH HHS/United States
R01 MH068197/MH/NIMH NIH HHS/United States
R01 MH078773/MH/NIMH NIH HHS/United States
R01 MH083595/MH/NIMH NIH HHS/United States
R01 MH61173/MH/NIMH NIH HHS/United States
R01AI41413/AI/NIAID NIH HHS/United States
R01DA015679/DA/NIDA NIH HHS/United States
R01DA11869/DA/NIDA NIH HHS/United States
R01DA13826/DA/NIDA NIH HHS/United States
R01DA15215/DA/NIDA NIH HHS/United States
R01MH01584/MH/NIMH NIH HHS/United States
R01MH078773/MH/NIMH NIH HHS/United States
R01MH54907/MH/NIMH NIH HHS/United States
R01MH58986/MH/NIMH NIH HHS/United States
R01MH61695/MH/NIMH NIH HHS/United States
R01MH68197/MH/NIMH NIH HHS/United States
R01NR04749/NR/NINR NIH HHS/United States
Minority race/ethnicity is generally associated with antiretroviral therapy nonadherence in US-based studies. Limitations of the existing literature include small samples, subjective adherence measures, and inadequate control for potential confounders such as mental health and substance use, which have been consistently associated with poorer adherence.
Individual-level data were pooled from 13 US-based studies employing electronic drug monitoring to assess adherence. Adherence was operationalized as percent of prescribed doses taken from the first 12 (monthly) waves of data in each study. Depression symptoms were aggregated from several widely used assessments, and substance use was operationalized as any use of cocaine/stimulants, heroin/opiates, ecstasy, hallucinogens, or sedatives in the 30–365 days preceding baseline.
The final analytic sample of 1809 participants ranged in age from 18 to 72 years and was 67% male. Participants were 53% African American, 14% Latino, and 34% White. In a logistic regression adjusting for age, gender, income, education, and site, race/ethnicity was significantly associated with adherence (P < 0.001) and persisted in a model that also controlled for depression and substance use (P < 0.001), with African Americans having significantly lower adherence than Latinos [odds ratio (OR) = 0.72, P = 0.04] and whites (OR = 0.60, P < 0.001). Adherence did not differ between whites and Latinos (OR = 0.84, P = 0.27).
Racial/ethnic differences in demographics, depression, and substance abuse do not explain the lower level of antiretroviral therapy adherence in African Americans observed in our sample. Further research is needed to explain the persistent disparity and might examine factors such as mistrust of providers, health literacy, and inequities in the health care system.
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