title: Factors Associated with Adherence to Routine Screening Mammography in HIV-Infected Women.
abstract: Both HIV-infected women and minority women have historically lower rates of screening mammography. The objective of this study was to identify factors related to adherence to routine screening mammography in a diverse inner-city cohort of HIV-infected women, to inform future work on targeted interventions to address disparities.
  
  
  
  This retrospective cohort study reviewed the electronic medical record of HIV-infected women aged 40 and older engaged in care between October 1, 2003 and March 31, 2008 at a large urban safety-net HIV clinic. Analyses included chi square testing and multivariate logistic regression to assess for patient-specific factors associated with adherence to breast cancer screening, defined as obtaining a screening mammogram within 2 years of engaging in care.
  
  
  
  The 292 women were a racially diverse group, with 70% black, 11% Hispanic, and 42% foreign born. There was suboptimal HIV control, with only 33% having an undetectable viral load (VL). One hundred forty-six (50%) were adherent to screening mammography. In multivariate analysis, women who were foreign born (OR 2.65 [CI 1.52-4.64]) had not completed high school (OR 1.77 [CI 1.06-2.95]) or had an undetectable VL (OR 2.51 [CI 1.44-4.40]) had increased odds of obtaining a mammogram.
  
  
  
  Among a racially diverse urban population of HIV-infected women engaged in care, only half had a mammogram. Foreign-born women had higher odds of undergoing mammography, suggesting that nativity status and social determinants of health are under-recognized drivers of adherence in this population. Future programs targeting screening must be mindful of the multiple predictors of adherence.
authors.affiliation: 1 Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Boston University School of Medicine , Boston, Massachusetts.
authors.forename: Zoe M
authors.initials: ZM
authors.lastname: Weinstein
authors.affiliation: 2 Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine , Boston, Massachusetts.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Battaglia
authors.affiliation: 3 Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine , Philadelphia, Pennsylvania.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Baranoski
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control; D015331:Cohort Studies; D003266:Continuity of Patient Care; D057286:Electronic Health Records; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000208:ethnology* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D064890:Social Determinants of Health; D012959:Socioeconomic Factors; D014505:Urban Population