494   Differences in Prescription of Highly Active Antiretroviral Therapy Persist in 1999.

A. McNaghten, D. Hanson, and M. Dworkin.
CDC, Atlanta, GA.

Background:Differences in prescription of highly active antiretroviral therapy (HAART) by sex, race/ethnicity, and risk group have been reported. The objective of this analysis was to determine if gaps in HAART prescription have changed over time by characteristics of patient population.

Methods:We analyzed data from the Adult/Adolescent Spectrum of HIV Disease project, observing 16,989 patients in 11 US cities eligible for HAART, from January 1996 through June 1999. Using a logistic regression model of prescribed HAART, race and risk by sex were compared in 1996 and during the most recent year data were available, July 1998 through June 1999, to determine the magnitude of the gap between the two periods by race and risk by sex. The model included CD4⁺

project site, race, and risk by sex.

Results:The proportion of patients prescribed HAART increased from 19% during the first half of 1996 to 68% in the first half of 1999. During 1996, injection drug-using (IDU) males (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.41—0.57), IDU females (OR, 0.46; 95% CI, 0.38—0.56), heterosexual males (OR, 0.74; 95% CI, 0.54—1.00) and heterosexual females (OR, 0.75; 95% CI, 0.64—0.88) were less likely to receive HAART than men who have sex with men (MSM). Blacks (OR, 0.48; 95% CI, 0.43—0.53), Hispanics (OR, 0.76; 95% CI, 0.66—0.87), and Native Americans (OR, 0.41; 95% CI, 0.22—0.77) were less likely to receive HAART than whites. During July 1998 to June 1999, only IDU males (OR, 0.69; 95% CI, 0.60—0.81) and IDU females (OR, 0.60; 95% CI, 0.50—0.71) were less likely to receive HAART than MSM, and blacks (OR, 0.82; 95% CI, 0.74— 0.92) were less likely than whites.

Conclusions:We found an increasing proportion of eligible patients prescribed HAART from 1996 to 1999. Although we lacked insurance data during this period, increased drug assistance programs may have contributed to the increased proportion prescribed HAART. However, in 1999, blacks were less likely than whites, and IDUs were less likely than MSM, to be prescribed HAART. Differences between individual racial/ethnic groups and risk groups by sex changed over time among all groups except IDUs. Continued monitoring of differences in HAART prescription by gender, race/ethnicity, risk behaviors and other factors is needed to improve efforts to identify populations needing assistance in receiving care and treatment.