Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users

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. DESIGN: Retrospective cohort study. SETTING: New York State Medicaid program. PARTICIPANTS: One thousand eight hundred twenty-seven female and 3,246 male drug users on combination antiretroviral therapy for more than 2 months in 1997. MAIN MEASURES: A pharmacy-based measure of adherence was defined as greater than or equal to95% days covered by at least 2 prescribed antiretroviral drugs. Independent variables were: depression, regular drug treatment (greater than or equal to6 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.