Gender differences in factors associated with adherence to antiretroviral therapy

Karina M. Berg, Penelope A. Demas, Andrea A. Howard, Ellie Schoenbaum, Marc N. Gourevitch, Julia H. Arnsten

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

OBJECTIVE: To identify gender differences in social and behavioral factors associated with antiretroviral adherence. DESIG: Prospective cohort study. SETTING: Methadone maintenance program. PARTICIPANTS: One hundred thirteen HIV-seropositive current or former opioid users. MEASUREMENTS AND MAIN RESULTS: Participants were surveyed at baseline about social and behavioral characteristics and at monthly research visits about drug and alcohol use and medication side effects. Electronic monitors (MEMS) were used to measure antiretroviral adherence. Median adherence among women was 27% lower than among men (46% vs. 73%; P < .05). In gender-stratified multivariate models, factors associated with worse adherence in men included not belonging to an HIV support group (P < .0001), crack/cocaine use (P < .005), and medication side effects (P = .01). Among women, alcohol use (P = .005), heroin use (P < .05), and significant medication side effects (P < .005) were independently associated with worse adherence. In a model including both men and women, worse adherence was associated with lack of long-term housing (P < .005), not belonging to any HIV support groups (P < .0005), crack or cocaine use (P < .01), and medication side effects (P < .0005). In addition, worse adherence was associated with the interaction between female gender and alcohol use (P < .05). CONCLUSIONS: In this cohort of current and former opioid users, gender-stratified analysis demonstrated that different social and behavioral factors are associated with adherence in men and women. Among both men and women, worse adherence was associated with lack of long-term housing, not belonging to an HIV support group, crack/cocaine use, and medication side effects. Among women only, alcohol use was associated with worse adherence.

Original languageEnglish (US)
Pages (from-to)1111-1117
Number of pages7
JournalJournal of General Internal Medicine
Volume19
Issue number11
DOIs
StatePublished - Nov 2004

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Crack Cocaine
Self-Help Groups
Alcohols
HIV
Opioid Analgesics
Therapeutics
Micro-Electrical-Mechanical Systems
Methadone
Heroin
Cohort Studies
Prospective Studies
Research
Pharmaceutical Preparations

Keywords

  • Adherence
  • Alcohol
  • Antiretroviral therapy
  • Electronic monitors
  • Gender

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Gender differences in factors associated with adherence to antiretroviral therapy. / Berg, Karina M.; Demas, Penelope A.; Howard, Andrea A.; Schoenbaum, Ellie; Gourevitch, Marc N.; Arnsten, Julia H.

In: Journal of General Internal Medicine, Vol. 19, No. 11, 11.2004, p. 1111-1117.

Research output: Contribution to journalArticle

Berg, Karina M. ; Demas, Penelope A. ; Howard, Andrea A. ; Schoenbaum, Ellie ; Gourevitch, Marc N. ; Arnsten, Julia H. / Gender differences in factors associated with adherence to antiretroviral therapy. In: Journal of General Internal Medicine. 2004 ; Vol. 19, No. 11. pp. 1111-1117.
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abstract = "OBJECTIVE: To identify gender differences in social and behavioral factors associated with antiretroviral adherence. DESIG: Prospective cohort study. SETTING: Methadone maintenance program. PARTICIPANTS: One hundred thirteen HIV-seropositive current or former opioid users. MEASUREMENTS AND MAIN RESULTS: Participants were surveyed at baseline about social and behavioral characteristics and at monthly research visits about drug and alcohol use and medication side effects. Electronic monitors (MEMS) were used to measure antiretroviral adherence. Median adherence among women was 27{\%} lower than among men (46{\%} vs. 73{\%}; P < .05). In gender-stratified multivariate models, factors associated with worse adherence in men included not belonging to an HIV support group (P < .0001), crack/cocaine use (P < .005), and medication side effects (P = .01). Among women, alcohol use (P = .005), heroin use (P < .05), and significant medication side effects (P < .005) were independently associated with worse adherence. In a model including both men and women, worse adherence was associated with lack of long-term housing (P < .005), not belonging to any HIV support groups (P < .0005), crack or cocaine use (P < .01), and medication side effects (P < .0005). In addition, worse adherence was associated with the interaction between female gender and alcohol use (P < .05). CONCLUSIONS: In this cohort of current and former opioid users, gender-stratified analysis demonstrated that different social and behavioral factors are associated with adherence in men and women. Among both men and women, worse adherence was associated with lack of long-term housing, not belonging to an HIV support group, crack/cocaine use, and medication side effects. Among women only, alcohol use was associated with worse adherence.",
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