title: Racial/Ethnic disparities in ART adherence in the United States: findings from the MACH14 study.
abstract: BACKGROUND
  Minority race/ethnicity is generally associated with antiretroviral therapy nonadherence in US-based studies. Limitations of the existing literature include small samples, subjective adherence measures, and inadequate control for potential confounders such as mental health and substance use, which have been consistently associated with poorer adherence.
  
  
  METHODS
  Individual-level data were pooled from 13 US-based studies employing electronic drug monitoring to assess adherence. Adherence was operationalized as percent of prescribed doses taken from the first 12 (monthly) waves of data in each study. Depression symptoms were aggregated from several widely used assessments, and substance use was operationalized as any use of cocaine/stimulants, heroin/opiates, ecstasy, hallucinogens, or sedatives in the 30-365 days preceding baseline.
  
  
  RESULTS
  The final analytic sample of 1809 participants ranged in age from 18 to 72 years and was 67% male. Participants were 53% African American, 14% Latino, and 34% White. In a logistic regression adjusting for age, gender, income, education, and site, race/ethnicity was significantly associated with adherence (P < 0.001) and persisted in a model that also controlled for depression and substance use (P < 0.001), with African Americans having significantly lower adherence than Latinos [odds ratio (OR) = 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).
  
  
  CONCLUSIONS
  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. Further research is needed to explain the persistent disparity and might examine factors such as mistrust of providers, health literacy, and inequities in the health care system.
authors.affiliation: Department of Psychology, University of Washington, Seattle, WA 98195, USA. jsimoni@uw.edu
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.forename: David
authors.initials: D
authors.lastname: Huh
authors.forename: Ira B
authors.initials: IB
authors.lastname: Wilson
authors.forename: Jie
authors.initials: J
authors.lastname: Shen
authors.forename: Kathy
authors.initials: K
authors.lastname: Goggin
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Reynolds
authors.forename: Robert H
authors.initials: RH
authors.lastname: Remien
authors.forename: Marc I
authors.initials: MI
authors.lastname: Rosen
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Honghu
authors.initials: H
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents