title: Association between race, depression, and antiretroviral therapy adherence in a low-income population with HIV infection.
abstract: BACKGROUND
  Racial disparities exist in many aspects of HIV/AIDS. Comorbid depression adds to the complexity of disease management. However, prior research does not clearly show an association between race and antiretroviral therapy (ART) adherence, or depression and adherence. It is also not known whether the co-existence of depression modifies any racial differences that may exist.
  
  
  OBJECTIVE
  To examine racial differences in ART adherence and whether the presence of comorbid depression moderates these differences among Medicaid-enrolled HIV-infected patients.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Multi-state Medicaid database (Thomson Reuters MarketScan®).
  
  
  METHODS
  Data for 7,034 HIV-infected patients with at least two months of antiretroviral drug claims between 2003 and 2007 were assessed.
  
  
  METHODS
  Antiretroviral therapy adherence (90 % days covered) were measured for a 12-month period. The main independent variables of interest were race and depression. Other covariates included patient variables, clinical variables (comorbidity and disease severity), and therapy-related variables.
  
  
  RESULTS
  In this study sample, over 66 % of patients were of black race, and almost 50 % experienced depression during the study period. A significantly higher portion of non-black patients were able to achieve optimal adherence (≥90 %) compared to black patients (38.6 % vs. 28.7 %, p < 0.001). In fact, black patients had nearly 30 % decreased odds of being optimally adherent to antiretroviral drugs compared to non-black patients (OR = 0.70, 95 % CI: 0.63-0.78), and was unchanged regard less of whether the patient had depression. Antidepressant treatment nearly doubled the odds of optimal ART adherence among patients with depression (OR = 1.92, 95 % CI: 1.12-3.29).
  
  
  CONCLUSIONS
  Black race was significantly associated with worse ART adherence, which was not modified by the presence of depression. Under-diagnosis and under-treatment of depression may hinder ART adherence among HIV-infected patients of all races.
authors.affiliation: College of Pharmacy, Ohio State University, Columbus, OH, USA.
authors.forename: Meg C
authors.initials: MC
authors.lastname: Kong
authors.forename: Milap C
authors.initials: MC
authors.lastname: Nahata
authors.forename: Veronique A
authors.initials: VA
authors.lastname: Lacombe
authors.forename: Eric E
authors.initials: EE
authors.lastname: Seiber
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy / Q000191:economics / Q000208:ethnology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics / Q000208:ethnology*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D011203:Poverty / Q000191:economics / Q000208:ethnology*; D044469:Racial Groups / Q000208:ethnology*; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents; D000928:Antidepressive Agents