Palacio Herminia, Kahn James G, Richards T Anne, Morin Stephen F
Houston Center for Quality of Care and Utilization Studies, Veterans Affairs Medical Center (152), 2002 Holcombe Boulevard, Houston, TX 77030, USA.
Public Health Rep. 2002 May-Jun;117(3):233-51; discussion 231-2. doi: 10.1093/phr/117.3.233.
The authors performed a systematic and critical review of published studies investigating potential associations between race and/or ethnicity and use of HIV-related medications, including antiretroviral medications and medications used for prophylaxis of opportunistic infections.
The authors conducted a Web-based search of the University of California MEDLINE/HealthSTAR database for articles published from January 1, 1985, to October 31, 2001. References cited in articles were used to identify potential additional articles for this review. The authors reviewed articles published in peer-reviewed scientific journals that analyzed race/ethnicity as a predictor of antiretroviral or HIV-related prophylactic medication use.
The authors identified 28 reports, including: (a) 26 studies published in 1991-2001 that addressed antiretroviral use, spanning data collection periods from 1984 to 1999; (b) 11 studies published in 1994-2001 that addressed prophylaxis for Pneumocystis carinii pneumonia (PCP), reporting on data collected from 1989 to 1998; and (c) three studies published from 1998 to 2001 that addressed prophylaxis for other opportunistic infections, reporting on data collected from 1993 to 1998. Among the studies that addressed antiretroviral use, 14 found a negative association between non-white race and at least one measure of antiretroviral use, three studies found a positive association, and 16 studies found no association; seven studies found mixed results across several measures of antiretroviral use. Only four of 11 studies found a negative association between race/ethnicity and PCP prophylaxis; the remainder found no association. Two out of three studies found a negative association between race/ethnicity and prophylaxis for other infections.
There is evidence of racial/ethnic disparities in utilization of antiretrovirals, which are known to be strongly associated with positive HIV health outcomes. It is now imperative for researchers and policy makers to better understand the causes of these disparities, evaluate programs that affect the delivery of HIV medications, and implement program and policy changes necessary to address the disparities.
作者对已发表的研究进行了系统且批判性的综述，这些研究调查了种族和/或族裔与使用艾滋病相关药物（包括抗逆转录病毒药物和用于预防机会性感染的药物）之间的潜在关联。
作者在加利福尼亚大学医学文献数据库/健康之星数据库中进行了基于网络的搜索，以查找1985年1月1日至2001年10月31日发表的文章。文章中引用的参考文献用于确定本次综述可能的其他文章。作者审阅了发表在同行评审科学期刊上的文章，这些文章将种族/族裔作为抗逆转录病毒药物或艾滋病相关预防药物使用的预测因素进行了分析。
作者确定了28份报告，包括：（a）1991年至2001年发表的26项研究，涉及抗逆转录病毒药物的使用，数据收集期从1984年至1999年；（b）1994年至2001年发表的11项研究，涉及卡氏肺孢子虫肺炎（PCP）的预防，报告了1989年至1998年收集的数据；（c）1998年至2001年发表的3项研究，涉及其他机会性感染的预防，报告了1993年至1998年收集的数据。在涉及抗逆转录病毒药物使用的研究中，14项研究发现非白人种族与至少一项抗逆转录病毒药物使用指标之间存在负相关，3项研究发现存在正相关，16项研究未发现相关性；7项研究在多项抗逆转录病毒药物使用指标上发现了混合结果。11项研究中只有4项发现种族/族裔与PCP预防之间存在负相关；其余研究未发现相关性。3项研究中有2项发现种族/族裔与其他感染的预防之间存在负相关。
有证据表明在抗逆转录病毒药物的使用方面存在种族/族裔差异，而抗逆转录病毒药物已知与良好的艾滋病健康结果密切相关。现在，研究人员和政策制定者必须更好地了解这些差异的原因，评估影响艾滋病药物供应的项目，并实施必要的项目和政策变革以解决这些差异。
