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      Antiretroviral Use Among Active Injection-Drug Users: The Role of Patient–Provider Engagement and Structural Factors

      research-article
      , M.P.H., Sc.D. 1 , , , M.D., M.P.H. 2 , , DrPH 3 , , M.D., M.P.H. 4 , , Ph.D. 5 , , Ph.D. 6 , , Ph.D. 1 , , M.D., M.P.H. 1 , , J.D., Ph.D. 7
      AIDS Patient Care and STDs
      Mary Ann Liebert, Inc.

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          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.

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          Author and article information

          Journal
          AIDS Patient Care STDS
          AIDS Patient Care STDS
          apc
          AIDS Patient Care and STDs
          Mary Ann Liebert, Inc. (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
          1087-2914
          1557-7449
          July 2010
          01 July 2010
          : 24
          : 7
          : 421-428
          Affiliations
          [ 1 ]Department of Health, Behavior and Society; Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
          [ 2 ]Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center , Bronx, New York.
          [ 3 ]At the time of the study, was at the Special Projects of National Significance, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland. Now at the Johns Hopkins School of Medicine , Baltimore, Maryland.
          [ 4 ]Departments of Pediatrics and Epidemiology and Public Health, Leonard M. Miller School of Medicine, University of Miami , Miami, Florida.
          [ 5 ]AIDS Research Institute, University of California , San Francisco, California.
          [ 6 ]At the time of the study was at the Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland. Now at Veterans Affairs, National Serious Mental Illness Treatment Research Evaluation Center, Ann Arbor, Michigan.
          [ 7 ]Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia.
          Author notes
          Address correspondence to: Amy R. Knowlton, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 286, Baltimore, MD 21205. E-mail: aknowlto@ 123456jhsph.edu
          Article
          PMC5206679 PMC5206679 5206679 10.1089/apc.2009.0240
          10.1089/apc.2009.0240
          5206679
          20578910
          8f7a09e7-5f0c-426c-b5a3-f7387f9c5832
          Copyright 2010, Mary Ann Liebert, Inc.
          History
          Page count
          Tables: 2, References: 55, Pages: 8
          Categories
          Article

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