Use of highly active antiretroviral therapy in HIV-infected women: impact of HIV specialist care.
OBJECTIVE
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.


METHODS
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 < or = .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.
Gardner
Lytt I
LI
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. lig0@cdc.gov
Holmberg
Scott D
SD
Moore
Janet
J
Arnsten
Julia H
JH
Mayer
Kenneth H
KH
Rompalo
Anne
A
Schuman
Paula
P
Smith
Dawn K
DK
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007348:Insurance, Health; D008875:Middle Aged; D020380:Needs Assessment; D016017:Odds Ratio; D010819:Physician's Role; D011020:Pneumonia, Pneumocystis / Q000517:prevention & control; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D013383:Suburban Population; D011795:Surveys and Questionnaires; D014481:United States
D019380:Anti-HIV Agents