Youth with HIV/AIDS and conduct disorder are less likely to use or adhere to antiretroviral therapy
Like their adult counterparts, adolescents with HIV/AIDS suffer from higher rates of anxiety and depression than their peers without HIV/AIDS. However, these psychiatric problems do not seem to affect their initiation of antiretroviral therapies (ART) or their adherence to their medication regimen. On the other hand, youth with HIV/AIDS and conduct disorder are less likely than those without conduct disorder to begin ART and to adhere to their drug regimen if they do begin ART, according to a new study. An association was found between ART use and number of visits to health care providers. Regardless of psychiatric status, those with more than 10 visits a year were significantly more likely to receive ART. Visit frequency was also significantly related to adherence.
Rutgers University researchers examined 1999-2000 Medicaid claims for pharmacy and medical services data from four States for youth 12 to 17 years old. A total of 834 adolescents were identified who received care for HIV/AIDS. Researchers compared this group with 272,157 youth who did not have HIV infection. Youth with HIV/AIDS were more likely to have Medicaid claims related to depression or anxiety compared with others, with 8.4 percent diagnosed with anxiety and 14.6 percent diagnosed with depression. A higher percentage of these youth also had claims for targeted case management compared with youth without HIV/AIDS (13.6 vs. 7 percent).
A total of 73 percent of youth with HIV/AIDS received ART during the study period. Adolescents aged 16 to 17 were only about half as likely to receive ART as those aged 12 to 13. Youth with comorbid conduct or emotional disorders were significantly less likely to receive ART. However, once ART was initiated, medication adherence did not significantly differ between adolescents living with a psychiatric condition and those who were not. The exception was adolescents with conduct disorder, who had lower medication adherence rates than others.
The study was supported in part by a grant from the Agency for Healthcare Research and Quality (HS16097) to the Rutgers University Center for Research and Education on Mental Health Therapeutics, part of AHRQ's Centers for Education and Research on Therapeutics (CERTs) Program. For more information on the CERTs Program, visit http://www.certs.hhs.gov.
See "Psychiatric diagnosis and antiretroviral adherence among adolescent Medicaid beneficiaries diagnosed with human immunodeficiency virus/acquired immunodeficiency syndrome," by James Walkup, Ph.D., Ayse Akincigil, Ph.D., Scott Bilder, M.S., and others in the May 2009 Journal of Nervous and Mental Disease 197(5), pp. 354-361.
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