Carter, Allison, Jeong Eun Min, William Chau, Viviane D. Lima, Mary Kestler, Neora Pick, Deborah Money, Julio S G. Montaner, Robert S. Hogg, and Angela Kaida. “Gender Inequities in Quality of Care among HIV-Positive Individuals Initiating Antiretroviral Treatment in British Columbia, Canada (2000–2010).” PLoS One 9, no. 3 (2014). doi: 10.1371/journal.pone.0092334

URL: www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0092334

Abstract

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).

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.

Compliance with antiretroviral treatment (ART) protocols during the first year of treatment is critical for long term survival for patients with HIV/AIDS. Carter et al. examined whether women in British Columbia, Canada with HIV/AIDS received a different quality of care during and after the first year of ART. Researchers found that there was a gender gap in the quality of care for patients starting ART, particularly among poorer and marginalized communities.