Patient Factors Predict HAART Use Among HIV-Positive Women
Originally published by Reuters Health, January 7, 2002
NEW YORK (Reuters Health) — Before the availability of highly active antiretroviral therapy (HAART), clinical and behavioral factors influenced the likelihood of receiving antiretroviral therapy. Since HAART, additional patient factors, including education, private insurance, abstaining from injection drug use, and not being African American, also appear to increase the likelihood of HAART use among HIV-positive women.
Over 6 months, Dr. Judith A. Cook from the University of Illinois at Chicago, and colleagues collected data for 1690 HIV-positive women, 17 to 73 years of age. Among these women, 57% were African American, 74% received some public health insurance and 41% had a history of injection drug use, according to the report in the January issue of the American Journal of Public Health.
Before HAART, factors associated with a significant likelihood of receiving antiretroviral therapy included low CD4+ cell count and high or low viral load. Subjects with HIV/AIDS-related symptoms and those participating in clinical trials were also more likely to report antiretroviral use. Factors such as ethnicity, education, age, health insurance, poverty and a history of injected drug use did not influence the likelihood of antiretroviral therapy, the researchers report.
After the introduction of HAART, women with low CD4+ cell counts and high viral loads were 4 time more likely to use HAART, compared with women with high CD4+ cell counts and low viral loads. Women with low CD4+ cell counts and low viral loads were 2.9 times as likely to use HAART and women with high CD4+ cell counts and high viral loads were 2.4 times more likely to use HAART, they found.
In the later period, women with some college education were also significantly more likely to use HAART (odds ratio 1.19), as were women with private health insurance (odds ratio 1.29) and those who had participated in clinical drug trials (odds ratio 1.34), Dr. Cook's team found.
However, African American women were significantly less likely to use HAART (odds ratio 0.80), as were women with a history of injected drug use (odds ratio 0.79) and women who reported recent drug or alcohol use (odds ratio 0.82). Women in Chicago and Los Angeles were also significantly more likely to use HAART compared with women in San Francisco, they note.
Dr. Cook and colleagues conclude that "awareness of these factors points to needed supports and services that can increase our potential to provide the latest, highest-quality antiretroviral therapy to the largest numbers of eligible HIV-positive women."
The researchers hope this information "can be applied to empower women's medical decision making in collaboration with their healthcare providers and thus improve their clinical outcomes and quality of life."
