title: Use of highly active antiretroviral therapy in HIV-infected women: impact of HIV specialist care.
abstract: 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.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. lig0@cdc.gov
authors.forename: Lytt I
authors.initials: LI
authors.lastname: Gardner
authors.forename: Scott D
authors.initials: SD
authors.lastname: Holmberg
authors.forename: Janet
authors.initials: J
authors.lastname: Moore
authors.forename: Julia H
authors.initials: JH
authors.lastname: Arnsten
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Anne
authors.initials: A
authors.lastname: Rompalo
authors.forename: Paula
authors.initials: P
authors.lastname: Schuman
authors.forename: Dawn K
authors.initials: DK
authors.lastname: Smith
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents