National HIV Prevention Conference Atlanta, Georgia, USA — August 29- September 1, 1999

Natl HIV Prev Conf 1999 Aug 29-Sep 1:(abstract no. 751)
AUTHORS: Gardner L; Moore J; Arnsten J; Mayer K; Rompalo A ; Schuman P and Smith, D.
Centers for Disease Control and Prevention, Atlanta, GA; Montefiore Med Center, Bronx, NY; Brown Univ., Providence, RI; Johns Hopkins Univ., Baltimore, MD; Wayne State Univ., Detroit, MI.

BACKGROUND/OBJECTIVES: Use of HIV specialist clinics for HIV treatment has been linked in previous studies to greater use of antiretroviral therapy (ART) or highly active ART (HAART). It has not yet been established which factors other than insurance are consistently linked to the choice of HIV specialist clinics for the treatment of HIV infection. Our objective was to evaluate the association of current substance use and depression with self-reported attendance at HIV specialist clinics and use of ART in a cohort of HIV-infected women.

METHODS: The HIV Epidemiology Research Study (HERS) is a multi-site prospective study of HIV-infected and at-risk women in four urban sites in the U. S. This analysis is restricted to 277 HIV-infected women at sites which monitor rather than supply HIV treatment. A cross-sectional analysis was done on the latest study visit for 1998. Logistic regression was used to determine which factors were associated with use of a patient-defined HIV specialty clinic, controlling for age, education, CD4+ cell count, insurance and income category.

RESULTS: 51 (19%) of the women received HIV treatment at other than an HIV specialty clinic, 81% received HIV treatment at a specialty clinic. 25% of women reporting HIV specialty clinic use received HAART compared to 10% of women receiving care elsewhere (OR_uni=3.1; p=0.02), a difference that remained for women with CD4+ cell counts below 500/mm³. Less Pneumocysitis carinii prophylaxis use in women who had <200 CD4+cells/mm³ was reported by those receiving care at other than an HIV specialty clinic (OR_uni=2.5; p=0.07). Women receiving care at other than an HIV specialty clinic were more likely to report having no insurance (OR_adj=6.8, p=0.005); 8th grade education or less (OR_adj =3.6; p=.0.06) being a current injection drug user (IDU)(OR_adj=2.4; p=0.05); and less likely to have psychological depression (OR_adj=0.4; p=0.01 ). Alcohol use and crack cocaine use were not independently associated with clinic type. Even for women cared for by HIV specialists, use of HAART by IDUs (13%) lagged behind that in non-IDUs (28%)(OR_uni=0.4 ; p=0.06).

CONCLUSION: Several factors are associated with women 's use of HIV specialty clinics and HAART. In particular, injection drug use is associated with less use of HIV specialty clinics and HAART. Even in IDU women who attend HIV specialists, use of ART is decreased compared to non-IDU women.

PRESENTER CONTACT INFORMATION:
Name: Lytt I. Gardner
Address: Centers for Disease Control and Prevention
DHAP-SE, Epi Branch, Executive Park
Atlanta, GA 30333
Telephone: (404) 636-6163
Fax: (404) 639-6127
E-mail: lig0@cdc.gov

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Centers for Disease Control and Prevention. National HIV Prevention Conference, 1999. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, August 29- September 1, 1999.

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