Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010).
OBJECTIVES: We measured gender differences in "Quality of Care" (QOC) during the first year after initiation of antiretroviral therapy and investigated factors associated with poorer QOC among women. DESIGN: QOC was estimated using the Programmatic Compliance Score (PCS), a validated metri...
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Public Library of Science (PLoS)
2014-01-01
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Series: | PLoS ONE |
Online Access: | http://europepmc.org/articles/PMC3958538?pdf=render |
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author | Allison Carter Jeong Eun Min William Chau Viviane D Lima Mary Kestler Neora Pick Deborah Money Julio S G Montaner Robert S Hogg Angela Kaida |
author_facet | Allison Carter Jeong Eun Min William Chau Viviane D Lima Mary Kestler Neora Pick Deborah Money Julio S G Montaner Robert S Hogg Angela Kaida |
author_sort | Allison Carter |
collection | DOAJ |
description | OBJECTIVES: We measured gender differences in "Quality of Care" (QOC) during the first year after initiation of antiretroviral therapy and investigated factors associated with poorer QOC among women. DESIGN: QOC was estimated using the Programmatic Compliance Score (PCS), a validated metric associated with all-cause mortality, among all patients (≥19 years) who initiated ART in British Columbia, Canada (2000-2010). METHODS: PCS includes six indicators of non-compliance with treatment initiation guidelines at baseline (not having drug resistance testing before treatment; starting on a non-recommended regimen; starting therapy at CD4<200 cells/mm3) and during first-year follow-up (receiving <3 CD4 tests; receiving <3 viral load tests; not achieving viral suppression within six months). Summary scores range from 0-6; higher scores indicate poorer QOC. Multivariable ordinal logistic regression was used to measure if female gender was an independent predictor of poorer QOC and factors associated with poorer QOC among women. RESULTS: QOC was determined for 3,642 patients (20% women). At baseline: 42% of women (34% men) did not have resistance testing before treatment; 17% of women (9% men) started on a non-recommended regimen (all p<0.001). At follow-up: 17% of women (11% men) received <3 CD4; 17% of women (11% men) received <3 VL; 50% of women (41% men) did not achieve viral suppression (all p<0.001). Overall, QOC was better among men (mean PSC = 1.54 (SD = 1.30)) compared with women (mean = 1.89 (SD = 1.37); p<0.001). In the multivariable model, female gender (AOR = 1.16 [95% CI: 0.99-1.35]; p = 0.062) remained associated with poorer QOC after covariate adjustment. Among women, those with injection drug use history, of Aboriginal ancestry, from Vancouver Island, and who initiated ART in earlier years were more likely to have poorer QOC. CONCLUSIONS: Poorer QOC among women, especially from marginalized communities, demands that barriers undermining women's access to high-quality care be addressed to improve treatment and health for women with HIV. |
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spelling | doaj.art-cce661eb0fa34511a92e6259ef8f4ae72022-12-22T03:36:59ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-0193e9233410.1371/journal.pone.0092334Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010).Allison CarterJeong Eun MinWilliam ChauViviane D LimaMary KestlerNeora PickDeborah MoneyJulio S G MontanerRobert S HoggAngela KaidaOBJECTIVES: We measured gender differences in "Quality of Care" (QOC) during the first year after initiation of antiretroviral therapy and investigated factors associated with poorer QOC among women. DESIGN: QOC was estimated using the Programmatic Compliance Score (PCS), a validated metric associated with all-cause mortality, among all patients (≥19 years) who initiated ART in British Columbia, Canada (2000-2010). METHODS: PCS includes six indicators of non-compliance with treatment initiation guidelines at baseline (not having drug resistance testing before treatment; starting on a non-recommended regimen; starting therapy at CD4<200 cells/mm3) and during first-year follow-up (receiving <3 CD4 tests; receiving <3 viral load tests; not achieving viral suppression within six months). Summary scores range from 0-6; higher scores indicate poorer QOC. Multivariable ordinal logistic regression was used to measure if female gender was an independent predictor of poorer QOC and factors associated with poorer QOC among women. RESULTS: QOC was determined for 3,642 patients (20% women). At baseline: 42% of women (34% men) did not have resistance testing before treatment; 17% of women (9% men) started on a non-recommended regimen (all p<0.001). At follow-up: 17% of women (11% men) received <3 CD4; 17% of women (11% men) received <3 VL; 50% of women (41% men) did not achieve viral suppression (all p<0.001). Overall, QOC was better among men (mean PSC = 1.54 (SD = 1.30)) compared with women (mean = 1.89 (SD = 1.37); p<0.001). In the multivariable model, female gender (AOR = 1.16 [95% CI: 0.99-1.35]; p = 0.062) remained associated with poorer QOC after covariate adjustment. Among women, those with injection drug use history, of Aboriginal ancestry, from Vancouver Island, and who initiated ART in earlier years were more likely to have poorer QOC. CONCLUSIONS: Poorer QOC among women, especially from marginalized communities, demands that barriers undermining women's access to high-quality care be addressed to improve treatment and health for women with HIV.http://europepmc.org/articles/PMC3958538?pdf=render |
spellingShingle | Allison Carter Jeong Eun Min William Chau Viviane D Lima Mary Kestler Neora Pick Deborah Money Julio S G Montaner Robert S Hogg Angela Kaida Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010). PLoS ONE |
title | Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010). |
title_full | Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010). |
title_fullStr | Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010). |
title_full_unstemmed | Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010). |
title_short | Gender inequities in quality of care among HIV-positive individuals initiating antiretroviral treatment in British Columbia, Canada (2000-2010). |
title_sort | gender inequities in quality of care among hiv positive individuals initiating antiretroviral treatment in british columbia canada 2000 2010 |
url | http://europepmc.org/articles/PMC3958538?pdf=render |
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