Socioeconomic status, access to triple therapy, and survival from HIV-disease since 1996

Evan Wood, Julio S G Montaner, Keith Chan, Mark W. Tyndall, Martin T. Schechter, David Bangsberg, Michael V. O'Shaughnessy, Robert S. Hogg

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Background: In the era before highly active antiretroviral therapy (HAART), socioeconomic status was associated with survival from HIV disease. We have explored socioeconomic status, access to triple therapy (HAART), and mortality in the context of a universal healthcare system. Methods: We evaluated 1408 individuals who initiated double or triple therapy between 1 August 1996 and 31 December 1999, and were followed until 31 March 2000. Cumulative HIV-related mortality rates were estimated using Kaplan-Meier methods and Cox proportional hazards regression. Results: In the overall Cox model, we found that adherence [risk ratio (RR) 0.83; per 10% increase], CD4 cell count (RR 1.53; per 100 cell decrease), and lower socioeconomic status (RR 2.19; high versus low), were associated with HIV-related mortality. However, socioeconomic status was not significant among patients prescribed triple therapy in a stratified analysis, or in a sub-analysis restricted to patients prescribed HAART in the initial regimen. When we investigated if inequitable access to HAART by socio-economic status could explain the discrepancy, we found that persons in the lower socio-economic strata were less likely to be prescribed triple therapy even after adjustment for clinical characteristics. Conclusion: In a universal healthcare system, socioeconomic status was strongly associated with HIV-related mortality. When we investigated possible explanations for this association, we found that individuals of lower socioeconomic status were less likely to receive triple therapy after adjustment for clinical characteristics. Our findings highlight the need for the monitoring of therapeutic guidelines to ensure equitable access, as treatment strategies are updated.

Original languageEnglish (US)
Pages (from-to)2065-2072
Number of pages8
JournalAIDS
Volume16
Issue number15
DOIs
StatePublished - Oct 18 2002
Externally publishedYes

Fingerprint

Social Class
HIV
Highly Active Antiretroviral Therapy
Survival
Mortality
Odds Ratio
Therapeutics
Economics
Delivery of Health Care
CD4 Lymphocyte Count
Proportional Hazards Models
Guidelines

Keywords

  • Access
  • HIV/AIDS
  • Socioeconomic status
  • Survival

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Wood, E., Montaner, J. S. G., Chan, K., Tyndall, M. W., Schechter, M. T., Bangsberg, D., ... Hogg, R. S. (2002). Socioeconomic status, access to triple therapy, and survival from HIV-disease since 1996. AIDS, 16(15), 2065-2072. https://doi.org/10.1097/00002030-200210180-00012

Socioeconomic status, access to triple therapy, and survival from HIV-disease since 1996. / Wood, Evan; Montaner, Julio S G; Chan, Keith; Tyndall, Mark W.; Schechter, Martin T.; Bangsberg, David; O'Shaughnessy, Michael V.; Hogg, Robert S.

In: AIDS, Vol. 16, No. 15, 18.10.2002, p. 2065-2072.

Research output: Contribution to journalArticle

Wood, E, Montaner, JSG, Chan, K, Tyndall, MW, Schechter, MT, Bangsberg, D, O'Shaughnessy, MV & Hogg, RS 2002, 'Socioeconomic status, access to triple therapy, and survival from HIV-disease since 1996', AIDS, vol. 16, no. 15, pp. 2065-2072. https://doi.org/10.1097/00002030-200210180-00012
Wood, Evan ; Montaner, Julio S G ; Chan, Keith ; Tyndall, Mark W. ; Schechter, Martin T. ; Bangsberg, David ; O'Shaughnessy, Michael V. ; Hogg, Robert S. / Socioeconomic status, access to triple therapy, and survival from HIV-disease since 1996. In: AIDS. 2002 ; Vol. 16, No. 15. pp. 2065-2072.
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