title: Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users.
abstract: BACKGROUND
  Antiretroviral adherence is worse in women than in men, and depression can influence medication adherence.
  
  
  OBJECTIVE
  To evaluate the relationship of gender, depression, medical care, and mental health care to adherence in HIV-infected drug users.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  New York State Medicaid program.
  
  
  METHODS
  One thousand eight hundred twenty-seven female and 3,246 male drug users on combination antiretroviral therapy for more than 2 months in 1997.
  
  
  METHODS
  A pharmacy-based measure of adherence was defined as > or =95% days covered by at least 2 prescribed antiretroviral drugs. Independent variables were: depression, regular drug treatment (> or =6 months), regular medical care (2+ and >35% of visits), HIV-focused care (2+ visits), psychiatric care (2+ visits), and antidepressant therapy.
  
  
  RESULTS
  Women were less adherent than men (18% vs 25%, respectively,P <.001) and more likely to be diagnosed with depression (34% vs 29%). In persons with depression, the adjusted odds ratio (AOR) for adherence was greater for those with psychiatric care alone (AOR 1.52; 95% confidence interval [95% CI], 1.03 to 2.26) or combined with antidepressants (AOR 1.49; 95% CI, 1.04 to 2.15). In separate models by gender in persons with depression, psychiatric care plus antidepressants had a slightly stronger association with adherence in women (AOR 1.92; 95% CI, 1.00 to 3.68) than men (AOR, 1.26; 95% CI, 0.81 to 1.98). In drug users without depression, antidepressants alone were associated with greater adherence (AOR, 1.23; 95% CI, 1.02 to 1.49) with no difference by gender. Regular drug treatment was positively associated with adherence only in men.
  
  
  CONCLUSIONS
  In this drug-using cohort, women had worse pharmacy-measured antiretroviral adherence than men. Mental health care was significantly associated with adherence in women, while regular drug treatment was positively associated with adherence in men.
authors.affiliation: Received from the Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. bturner@mail.med.upenn.edu
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
authors.forename: Christine
authors.initials: C
authors.lastname: Laine
authors.forename: Leon
authors.initials: L
authors.lastname: Cosler
authors.forename: Walter W
authors.initials: WW
authors.lastname: Hauck
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D003695:Delivery of Health Care; D003863:Depression / Q000188:drug therapy / Q000209:etiology / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D009518:New York; D010349:Patient Compliance / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000517:prevention & control / Q000523:psychology*; D011795:Surveys and Questionnaires
chemical_list: D019380:Anti-HIV Agents; D000928:Antidepressive Agents