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Antiretroviral use among active injection-drug users: the role of patient-provider engagement and structural factors.

Abstract：

:HIV-seropositive, active injection-drug users (IDUs), compared with other HIV populations, continue to have low rates of highly active antiretroviral therapy (HAART) use, contributing to disparities in their HIV health outcomes. We sought to identify individual-level, interpersonal, and structural factors associated with HAART use among active IDUs to inform comprehensive, contextually tailored intervention to improve the HAART use of IDUs. Prospective data from three semiannual assessments were combined, and logistic general estimating equations were used to identify variables associated with taking HAART 6 months later. Participants were a community sample of HIV-seropositive, active IDUs enrolled in the INSPIRE study, a U.S. multisite (Baltimore, Miami, New York, San Francisco) prevention intervention. The analytic sample included 1,225 observations, and comprised 62% males, 75% active drug users, 75% non-Hispanic blacks, and 55% with a CD4 count <350; 48% reported HAART use. Adjusted analyses indicated that the later HAART use of IDUs was independently predicted by patient-provider engagement, stable housing, medical coverage, and more HIV primary care visits. Significant individual factors included not currently using drugs and a positive attitude about HAART benefits even if using illicit drugs. Those who reported patient-centered interactions with their HIV primary care provider had a 45% greater odds of later HAART use, and those with stable housing had twofold greater odds. These findings suggest that interventions to improve the HIV treatment of IDUs and to reduce their HIV health disparities should be comprehensive, promoting better patient-provider engagement, stable housing, HAART education with regard to illicit drug use, and integration of drug-abuse treatment with HIV primary care.

journal_name

AIDS Patient Care STDS

journal_title

AIDS patient care and STDs

authors

Knowlton AR,Arnsten JH,Eldred LJ,Wilkinson JD,Shade SB,Bohnert AS,Yang C,Wissow LS,Purcell DW

doi

10.1089/apc.2009.0240

subject

Has Abstract

pub_date

2010-07-01 00:00:00

pages

421-8

issue

eissn

1087-2914

issn

1557-7449

journal_volume

pub_type

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Antiretroviral use among active injection-drug users: the role of patient-provider engagement and structural factors.