Cognitive–affective depressive symptoms and substance use among Latino and non-Latino White patients in HIV care: an analysis of the CFAR network of integrated clinical systems cohort
The disparity in viral suppression rates between Latino and non-Latino White patients in HIV care appears to be narrowing, but it is unclear if depression and substance use perpetuate this disparity. We analyzed electronic medical records from the CFAR network of integrated clinical systems cohort. First observations/enrollment data collected between 2007 and 2013 were analyzed, which included survey (race/ethnicity, depression, substance use, adherence) and clinical data (viral suppression). We estimated indirect effects with a regression-based bootstrapping method. In 3129 observations, Latinos and non-Latino Whites did not differ in depression or alcohol use (ORs 1.11, 0.99, ns), but did in drug use (OR 1.13, p < .001). For all patients, depression and substance use were indirectly associated with small increases (ORs 1.02–1.66) in the odds for a detectable viral load, via worse adherence. We conclude that variables not captured in EMR systems (e.g., health literacy, structural factors) may better explain viral suppression disparities that persist.
KeywordsHIV/AIDS Latino/hispanic Mental health Substance use Viral suppression
This study and the authors were supported by Grants P30AI027763, K01MH113475, R24AI067039, R01MH102198, and K24DA037034 from the National Institutes of Health (NIH).
Compliance with ethical standards
Conflict of interest
John A. Sauceda, Nadra E. Lisha, Torsten B. Neilands, Katerina A. Christopoulos, W. Christopher Mathews, Julie H. Levison, Ann M. Dennis and Mallory O. Johnson declare that they have no conflict of interest.
The University of California, San Francisco’s Institutional Review Board approved this study.
Human and animal rights and Informed consent
All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all individual participants included in the study.
- Althoff, K. N., Buchacz, K., Hall, I., Zhang, J., Hanna, D. B., Rebeiro, P., et al. (2012). U.S. trends in antiretroviral therapy use, HIV RNA plasma viral loads, and CD4 T-lymphocyte cell counts among HIV-infected persons, 2000–2008. Annals of Internal Medicine, 157, 325–335. https://doi.org/10.7326/0003-4819-157-5-201209040-00005 CrossRefGoogle Scholar
- Bing, E. G., Burnam, M. A., Longshore, D., Fleishman, J. A., Sherbourne, C. D., London, A. S., et al. (2001). Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Archives of General Psychiatry, 58, 721–728. https://doi.org/10.1001/archpsyc.58.8.721 CrossRefGoogle Scholar
- Centers for Disease Control. (2017). More people with HIV have the virus under control [news release]. CDC NCHHSTP Newsroom: Atlanta, GA; July 27, 2017. https://www.cdc.gov/nchhstp/newsroom/2017/2017-HIV-Continuum-Press-Release.html. Accessed December 23, 2017.
- de Jonge, P., Ormel, J., van den Brink, R. H., van Melle, J. P., Spijkerman, T. A., Kuijper, A., et al. (2006). Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. American Journal of Psychiatry, 163, 138–144. https://doi.org/10.1176/appi.ajp.163.1.138 CrossRefGoogle Scholar
- Gonzalez, J. S., Hendriksen, E. S., Collins, E. M., Durán, R. E., & Safren, S. A. (2009). Latinos and HIV/AIDS: Examining factors related to disparity and identifying opportunities for psychosocial intervention research. AIDS and Behavior, 13, 582–602. https://doi.org/10.1007/s10461-008-9402-4 CrossRefGoogle Scholar
- Kitahata, M. M., Rodriguez, B., Haubrich, R., Boswell, S., Mathews, W. C., Lederman, M. M., et al. (2008). Cohort profile: The centers for AIDS research network of integrated clinical systems. International Journal of Epidemiology, 37, 948–955. https://doi.org/10.1093/ije/dym231 CrossRefGoogle Scholar
- Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x CrossRefGoogle Scholar
- Langebeek, N., Gisolf, E. H., Reiss, P., Vervoort, S. C., Hafsteinsdottir, T. B., Ricther, C., et al. (2014). Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: A meta-analysis. BMC Medicine, 12, 142. https://doi.org/10.1186/s12916-014-0142-1 CrossRefGoogle Scholar
- Merlin, J. S., Cen, L., Praestgaard, A., Turner, M., Obando, A., Alpert, C., et al. (2012). Pain and physical and psychological symptoms in ambulatory HIV patients in the current treatment era. Journal of Pain and Symptom Management, 43, 638–645. https://doi.org/10.1016/j.jpainsymman.2011.04.019 CrossRefGoogle Scholar
- Nachega, J. B., Uthman, O. A., del Rio, C., Mugavero, M. J., Rees, H., & Mills, E. J. (2014). Addressing the Achilles’ heel in the HIV Care Continuum for Success of a test-and-treat strategy to achieve an AIDS-Free Generation. Clinical Infectious Diseases, 59, S21–S27. https://doi.org/10.1093/cid/ciu299 CrossRefGoogle Scholar
- Safren, S. A., Bedoya, C. A., O’Cleirigh, C., Biello, K. B., Pinkston, M. M., Stein, M. D., et al. (2016). Cognitive-behavioural therapy for adherence and depression in patients with HIV: A three-arm randomised controlled trial. Lancet HIV, 3, e529–e538. https://doi.org/10.1016/s2352-3018(16)30053-4 CrossRefGoogle Scholar
- Safren, S. A., O’Cleirigh, C. M., Bullis, J. R., Otto, M. W., Stein, M. D., & Pollack, M. H. (2012). Cognitive-behavioral therapy for adherence and depression (CBT-AD) in HIV-infection injection drug users: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 80, 404–415. https://doi.org/10.1037/a0028208 CrossRefGoogle Scholar
- Sauceda, J. A., Brooks, R. A., Xavier, J., Maiorana, A., Georgetti Gomez, L., Zamudio-Haas, S., Rodriguez-Diaz, C. E., et al. (2018). From theory to application: A description of transnationalism in culturally-appropriate HIV interventions of outreach, access, and retention among Latino/a populations. Journal of Immigrant and Minority Health. https://doi.org/10.1007/s10903-018-0753-2
- Sauceda, J. A., Johnson, M. O., & Saberi, P. (2016). Nonadherence as 4-day antiretroviral therapy interruptions: Do depression and race/ethnicity matter as much in the modern antiretroviral therapy era? AIDS and Behavior, 20, 2624–2628. https://doi.org/10.1007/s10461-015-1283-8 CrossRefGoogle Scholar
- Sauceda, J. A., Neilands, T. B., Johnson, M. O., & Saberi, P. (2017). An updated on the barriers to adherence and a definition of self-report non-adherence given advancements in antiretroviral therapy (ART). AIDS and Behavior, 22, 939–947. https://doi.org/10.1007/s10461-017-1759-9 CrossRefGoogle Scholar
- Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption II. Addiction, 88, 791–804. https://doi.org/10.1111/j.1360-0443 CrossRefGoogle Scholar
- Simoni, J. M., Kurth, A. E., Pearson, C. R., Pantalone, D. W., Merrill, J. O., & Frick, P. A. (2006). Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. AIDS and Behavior, 10, 227–245. https://doi.org/10.1007/s10461-006-9078-6 CrossRefGoogle Scholar
- Simoni, J. M., Wiebe, J. S., Sauceda, J. A., Huh, D., Sanchez, G., Longoria, V., et al. (2013). A preliminary RCT of CBT-AD for adherence and depression among HIV-positive Latinos on the U.S.-Mexico Border: The Nuevo Día Study. AIDS and Behavior, 17, 2816–2829. https://doi.org/10.1007/s10461-013-0538-5 CrossRefGoogle Scholar
- Uthman, O. A., Magidson, J. F., Safren, S. A., & Nachega, J. B. (2014). Depression and adherence to antiretroviral therapy in low-middle-and high-income countries: A systematic review and meta-anlysis. Current HIV/AIDS Reports, 3, 291–307. https://doi.org/10.1007/s11904-014-022-1 CrossRefGoogle Scholar