In U.S.-based studies, minority race/ethnicity is generally associated with failure to adhere to antiretroviral therapy, observed the authors of the current report. However, study limitations include small samples, subjective adherence measures, and insufficient control of potential confounders associated with poorer adherence, such as mental health and substance abuse.
For this report, the investigators pooled individual-level data from 13 U.S.-based studies with electronic monitoring to assess adherence. For each study, adherence was operationalized as the percent of prescribed doses taken from the first 12 (monthly) waves of data for each study. Depression symptoms were aggregated from several common assessments; substance use was any use of cocaine/stimulants, heroin/opiates, ecstasy, hallucinogens, or sedatives in the 30-365 days before baseline.
For the analysis, the final sample of 1,809 participants were ages 18-72; 67 percent male; 53 percent African-American; 14 percent Latino; and 34 percent white. In a logistic regression -- adjusting for age, gender, income, education and site -- race/ethnicity was significantly associated with adherence (P<0.001), and continued after controlling for depression and substance use (P<0.001), with adherence for African Americans significantly lower than for Latinos (odds ratio=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," the authors concluded. "Further research is needed to explain the persistent disparity and might examine factors such as mistrust of providers, health literacy, and inequalities in the health care system."
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