Factors Associated With HIV-Infected Patients' Recognition and Use of HIV Medications

Abstract

In 1996, we interviewed 224 HIV-infected patients (54% men, 63% African American) receiving HIV medical care in St. Louis, Missouri about their recognition, prior use, and current use of HIV medications. Of 221 respondents who had heard of at least one antiretroviral drug, only 2 respondents reported they had never taken antiretroviral drugs. Multivariate logistic regression among respondents with CD4 counts <500 cells/mm3 identified sociodemographic variables (gender, race, education, and site of care) that were significantly (p < .05) associated with never having heard of, never having used, and not currently using specific antiretroviral drugs. African Americans in general, African American women, or African Americans with 12 years of schooling were more likely never to have heard of didanosine (ddI)/zalcitabine (ddC), stavudine (d4T), lamivudine (3TC), protease inhibitors, and non-nucleoside reverse transcriptase inhibitors (NNRTIs). In addition, women were more likely never to have heard of protease inhibitors, and respondents with < or = 12 years of schooling were more likely never to have heard of NNRTIs. African Americans were more likely never to have taken azidothymidine (AZT), and African American women were more likely never to have taken 3TC and protease inhibitors. Sociodemographic variables were not significantly associated with current use of specific antiretroviral drugs among those with CD4 levels <500 cells/mm3, nor with recognition, prior use, or current use of Pneumocystis carinii pneumonia prophylaxis among those with CD4 counts <200 cells/mm3. Findings indicate that, even among patients receiving HIV care, African Americans, women, and those with < or = 12 years of schooling were more likely never to have heard of and never to have used various specific antiretroviral medications. More focused efforts are needed to help patients become aware of available antiretroviral drugs and to encourage greater use of these drugs among all patients for whom the drugs are indicated.

Effect of race and/or ethnicity in use of antiretrovirals and prophylaxis for opportunistic infection: a review of the literature

“…In 1996, a study of 224 people receiving HIV medical care in St. Louis found that 98% of clients reported having heard of AZT and 83% of these reported having taken the drug. 45 Among 1,034 adults recruited from a Los Angeles-area AIDS service organization, 66% reported taking a protease inhibitor in November 1996. 46 Among injection drug users with AIDS who were enrolled in New Jersey Medicaid in 1988-1996, 74% had a prescription filled for at least one antiretroviral medication.…”

“…(See Table 1.) Overall, 15 studies had data collection periods that included 1996 or later, [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] i.e., after FDA approval for use of the first protease inhibitor in late 1995. Ten of the these reports specifically measured the use of either protease inhibitors, NNRTIs, or HAART.…”

“…Ten of the these reports specifically measured the use of either protease inhibitors, NNRTIs, or HAART. [45][46][47][48]50,[53][54][55][56][57] Overall, 14 studies found a negative association between non-white race and antiretroviral use in one or more multivariate analyses. 32,36-39,45-48,52-55 Among these 14, eight studies found only a negative association across all outcomes assessed, 32,[36][37][38][39]45,55,56 and six studies found mixed results depending on the specific outcome measure.…”

“…[45][46][47][48]50,[53][54][55][56][57] Overall, 14 studies found a negative association between non-white race and antiretroviral use in one or more multivariate analyses. 32,36-39,45-48,52-55 Among these 14, eight studies found only a negative association across all outcomes assessed, 32,[36][37][38][39]45,55,56 and six studies found mixed results depending on the specific outcome measure. 37,45,48,[52][53][54] Three studies found a positive association with at least one antiretroviral use measure, 40,44,48 two of which found either no association 44 or a negative association 48 across a different measure of antiretroviral use.…”

“…37,45,48,[52][53][54] Three studies found a positive association with at least one antiretroviral use measure, 40,44,48 two of which found either no association 44 or a negative association 48 across a different measure of antiretroviral use. Sixteen studies found no association between race/ethnicity and at least one measure of antiretroviral use; [33][34][35]37,[41][42][43][44][45][49][50][51][52][53][54]57 however, five of these also found a negative association on at least one antiretroviral use measure, 37,45,52-54 and one also found a positive association. 44 In four of these studies an association between race/ethnicity and antiretroviral use explicitly noted in bivariate analyses lost statistical significance after adjustment for other covariates.…”