Presentation (CTI)

OBJECTIVES: To examine how race, socioeconomic status, and depressive symptoms jointly influence access to pharmacologic treatments, ART and antidepressant adherence, and HIV-related outcomes among African American women. A secondary objective evaluated how untreated depression reduces the clinical and economic value of ART.
METHODS: Data were drawn from the Women’s Interagency HIV Study (WIHS; baseline n=1,411; 12,280 visits; Miami subsample 2013-2022). Measures included depressive symptoms (CES-D), ART adherence, antidepressant use, CD4 count, income, education, insurance, and virologic failure. Analyses included descriptive statistics, Pearson/Spearman correlations, multivariate logistic regression, and marginal structural Poisson models. A national WIHS estimate of 12% virologic failure was applied as a defensible proxy for Miami.
RESULTS: Socioeconomic vulnerability was substantial (68% income ≤$18,000; 66% unemployed). Depressive symptoms were common (69%) and inversely associated with ART adherence (r = -0.16, p < .05). Persistent depression reduced the likelihood of achieving ≥95% adherence by 54%. Viral suppression disparities persisted (61% among African American vs. 72% among White women). Untreated depression weakened ART’s real-world effectiveness, lowering treatment value.
CONCLUSIONS: These findings illustrate that HEOR researchers must prioritize intersectional disparities: untreated depression generates avoidable costs, reduces treatment value, and perpetuates inequities despite effective HIV therapies. Overly generalized models mask clinically meaningful disparities, misestimate treatment effectiveness, and risk policy decisions that fail to reach the most vulnerable populations. HEOR can lead the transformation of HIV care by informing equitable reimbursement models, integrating mental-health services, and optimizing resource allocation for low-income African American women—advancing policy, improving access, and maximizing value across the care continuum.