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Substance use and the HIV care continuum: important advances

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Addiction Science & Clinical Practice

BioMed Central

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      Most cited references 19

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      Closing the Gap: Increases in Life Expectancy among Treated HIV-Positive Individuals in the United States and Canada

      Background Combination antiretroviral therapy (ART) has significantly increased survival among HIV-positive adults in the United States (U.S.) and Canada, but gains in life expectancy for this region have not been well characterized. We aim to estimate temporal changes in life expectancy among HIV-positive adults on ART from 2000–2007 in the U.S. and Canada. Methods Participants were from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), aged ≥20 years and on ART. Mortality rates were calculated using participants' person-time from January 1, 2000 or ART initiation until death, loss to follow-up, or administrative censoring December 31, 2007. Life expectancy at age 20, defined as the average number of additional years that a person of a specific age will live, provided the current age-specific mortality rates remain constant, was estimated using abridged life tables. Results The crude mortality rate was 19.8/1,000 person-years, among 22,937 individuals contributing 82,022 person-years and 1,622 deaths. Life expectancy increased from 36.1 [standard error (SE) 0.5] to 51.4 [SE 0.5] years from 2000–2002 to 2006–2007. Men and women had comparable life expectancies in all periods except the last (2006–2007). Life expectancy was lower for individuals with a history of injection drug use, non-whites, and in patients with baseline CD4 counts <350 cells/mm3. Conclusions A 20-year-old HIV-positive adult on ART in the U.S. or Canada is expected to live into their early 70 s, a life expectancy approaching that of the general population. Differences by sex, race, HIV transmission risk group, and CD4 count remain.
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        Stop talking 'dirty': clinicians, language, and quality of care for the leading cause of preventable death in the United States.

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          Acceptability of a mobile health intervention to enhance HIV care coordination for patients with substance use disorders

          Background Persons living with HIV and substance use disorders face barriers to sustained engagement in medical care, leading to suboptimal antiretroviral treatment outcomes. Innovative mobile technology tools such as customizable smartphone applications have the potential to enhance existing care coordination programs, but have not been rigorously studied. Methods We developed and implemented a two-component intervention consisting of peer health navigation supported by a smartphone application conducting ecologic momentary assessment (EMA) of barriers to care and medication adherence. Patients with a history of antiretroviral treatment failure and substance use were recruited to participate in the 9-month pilot intervention. Three peer health navigators were trained to provide social and logistical support while participants re-engaged in HIV care. We assessed the acceptability of the intervention components using qualitative analysis of in-depth interviews conducted with study participants and peer navigators. Results Of 19 patients enrolled in the study, 17 participated for at least 2 months and 15 completed the entire 9-month study protocol. The acceptability of the peer navigation intervention was rated favorably by all participants interviewed, who felt that peer support was instrumental in helping them re-engage in HIV care. Participants also responded favorably to the smartphone application, but described its usefulness mostly as providing reminders to take medications and attend appointments, rather than as a facilitator of patient navigation. Conclusions Peer health navigation and smartphone-based EMA are acceptable approaches to facilitating engagement in HIV care for drug using populations. Future studies to evaluate the efficacy of this approach for improving long-term retention in care and antiretroviral treatment outcomes are warranted. ClinicalTrials.gov Identifier NCT01941108; registered on September 4, 2013
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            Author and article information

            Affiliations
            [1 ]ISNI 0000 0000 9758 5690, GRID grid.5288.7, Department of Medicine, Section of Addiction Medicine, , Oregon Health and Science University, ; 3181 SW Sam Jackson Park Rd., L475, Portland, OR 97239-3088 USA
            [2 ]ISNI 0000000419368710, GRID grid.47100.32, Yale University School of Medicine, ; New Haven, CT USA
            Contributors
            (503) 494-8044 , korthuis@ohsu.edu
            Journal
            Addict Sci Clin Pract
            Addict Sci Clin Pract
            Addiction Science & Clinical Practice
            BioMed Central (London )
            1940-0632
            1940-0640
            12 March 2018
            12 March 2018
            2018
            : 13
            29530080
            5848588
            114
            10.1186/s13722-018-0114-4
            © The Author(s) 2018

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

            Funding
            Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
            Award ID: UG3DA044831
            Award ID: UG1DA015815
            Award ID: R01DA04071
            Award Recipient :
            Funded by: National Institute on Drug Abuse (US)
            Award ID: R01DA037441
            Award ID: R01DA041067
            Award ID: UG1DA015831
            Award Recipient :
            Funded by: National Institute on Alcohol Abuse and Alcoholism (US)
            Award ID: U01AA020795
            Award ID: U01AA020790
            Award Recipient :
            Categories
            Editorial
            Custom metadata
            © The Author(s) 2018

            Health & Social care

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