Use of highly active antiretroviral therapy in HIV-infected women: Impact of HIV specialist care

Lytt I. Gardner, Scott D. Holmberg, Janet Moore, Julia H. Arnsten, Kenneth H. Mayer, Anne Marie Rompalo, Paula Schuman, Dawn K. Smith

Research output: Contribution to journalArticle

Abstract

Objectives: To evaluate factors associated with use of HIV specialist care by women, and to determine whether medical indications for therapy validate lower rates of antiretroviral use in women not using HIV specialty care. Design: Cross-sectional analysis of the 1998 interview from the HIV Epidemiology Research Study (HERS) cohort. Methods: Data from 273 HIV-infected women in the HERS were analyzed by multiple logistic regression to calculate predictors of the use of HIV specialist care providers. Variables included study site, age, education, insurance status, income, substance abuse, depression, AIDS diagnosis, CD4+ lymphocyte count, and HIV-1 viral load. In addition, medical indications for therapy and medical advice to begin antiretroviral therapy were assessed. Results: Of 273 women, 222 (81%) used HIV specialists and 51 (19%) did not. Having health insurance, not being an injection drug user, and being depressed were predictive of using HIV specialist care (all p ≤.05). Although medical indications for therapy in the two groups were comparable, the rate of highly active antiretroviral therapy (HAART) use was significantly higher in women using HIV specialist care (27%) compared with those not using HIV specialists (7.8%). Women using HIV specialists received significantly more advice to begin antiretroviral therapy (ART) in the 6 months prior to the interview compared with those not using specialists (relative risk, 2.4; 95% CI = 1.3-4.6). Conclusions: Having insurance, not being an injection drug user, and being depressed all increased the likelihood of women receiving HIV specialty care, which, in turn, increased the likelihood of receiving recommended therapies. The level of HAART use (23%) and any ART use (47%) in these HIV-infected women was disturbingly low. Despite comparable medical indications, fewer women obtaining care from other than HIV specialists received HAART. These data indicate substantial gaps in access to HIV specialist care and thereby to currently recommended antiretroviral treatment.

Original languageEnglish (US)
Pages (from-to)69-75
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume29
Issue number1
StatePublished - Jan 1 2002
Externally publishedYes

Fingerprint

Highly Active Antiretroviral Therapy
HIV
Therapeutics
Drug Users
Epidemiology
Interviews
Injections
Insurance Coverage
Health Insurance
CD4 Lymphocyte Count
Insurance
Viral Load
Research
Substance-Related Disorders
HIV-1

Keywords

  • Antiretroviral therapy
  • HAART
  • HIV
  • HIV specialists
  • Medical care
  • Women

ASJC Scopus subject areas

  • Virology
  • Immunology

Cite this

Gardner, L. I., Holmberg, S. D., Moore, J., Arnsten, J. H., Mayer, K. H., Rompalo, A. M., ... Smith, D. K. (2002). Use of highly active antiretroviral therapy in HIV-infected women: Impact of HIV specialist care. Journal of Acquired Immune Deficiency Syndromes, 29(1), 69-75.

Use of highly active antiretroviral therapy in HIV-infected women : Impact of HIV specialist care. / Gardner, Lytt I.; Holmberg, Scott D.; Moore, Janet; Arnsten, Julia H.; Mayer, Kenneth H.; Rompalo, Anne Marie; Schuman, Paula; Smith, Dawn K.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 29, No. 1, 01.01.2002, p. 69-75.

Research output: Contribution to journalArticle

Gardner, LI, Holmberg, SD, Moore, J, Arnsten, JH, Mayer, KH, Rompalo, AM, Schuman, P & Smith, DK 2002, 'Use of highly active antiretroviral therapy in HIV-infected women: Impact of HIV specialist care', Journal of Acquired Immune Deficiency Syndromes, vol. 29, no. 1, pp. 69-75.
Gardner, Lytt I. ; Holmberg, Scott D. ; Moore, Janet ; Arnsten, Julia H. ; Mayer, Kenneth H. ; Rompalo, Anne Marie ; Schuman, Paula ; Smith, Dawn K. / Use of highly active antiretroviral therapy in HIV-infected women : Impact of HIV specialist care. In: Journal of Acquired Immune Deficiency Syndromes. 2002 ; Vol. 29, No. 1. pp. 69-75.
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abstract = "Objectives: To evaluate factors associated with use of HIV specialist care by women, and to determine whether medical indications for therapy validate lower rates of antiretroviral use in women not using HIV specialty care. Design: Cross-sectional analysis of the 1998 interview from the HIV Epidemiology Research Study (HERS) cohort. Methods: Data from 273 HIV-infected women in the HERS were analyzed by multiple logistic regression to calculate predictors of the use of HIV specialist care providers. Variables included study site, age, education, insurance status, income, substance abuse, depression, AIDS diagnosis, CD4+ lymphocyte count, and HIV-1 viral load. In addition, medical indications for therapy and medical advice to begin antiretroviral therapy were assessed. Results: Of 273 women, 222 (81{\%}) used HIV specialists and 51 (19{\%}) did not. Having health insurance, not being an injection drug user, and being depressed were predictive of using HIV specialist care (all p ≤.05). Although medical indications for therapy in the two groups were comparable, the rate of highly active antiretroviral therapy (HAART) use was significantly higher in women using HIV specialist care (27{\%}) compared with those not using HIV specialists (7.8{\%}). Women using HIV specialists received significantly more advice to begin antiretroviral therapy (ART) in the 6 months prior to the interview compared with those not using specialists (relative risk, 2.4; 95{\%} CI = 1.3-4.6). Conclusions: Having insurance, not being an injection drug user, and being depressed all increased the likelihood of women receiving HIV specialty care, which, in turn, increased the likelihood of receiving recommended therapies. The level of HAART use (23{\%}) and any ART use (47{\%}) in these HIV-infected women was disturbingly low. Despite comparable medical indications, fewer women obtaining care from other than HIV specialists received HAART. These data indicate substantial gaps in access to HIV specialist care and thereby to currently recommended antiretroviral treatment.",
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