Abstract
People living with HIV who use illicit drugs continue to experience high rates of suboptimal treatment outcomes from antiretroviral therapy (ART). Although previous studies have identified important behavioural, social and structural barriers to ART adherence, the effects of patient-level factors have not been fully evaluated. Thus, we sought to investigate the prevalence and correlates of reporting ART was difficult to take among a cohort of illicit drug users in Vancouver, Canada. We accessed data from the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), an ongoing prospective cohort of HIV-positive illicit drug users linked to comprehensive HIV clinical monitoring records. We used generalized linear mixed-effects modeling to identify factors longitudinally associated with periods in which individuals reported they found ART difficult to take. Between December 2005 and May 2014, 746 ART-exposed illicit drug users were recruited and contributed at least one study interview. Finding ART hard to take was reported by 209 (28.0%) participants at baseline, and 460 (61.7%) participants throughout the study period. Patients ingesting a greater daily pill count (adjusted odds ratio [AOR] = 1.12 per pill, 95% confidence interval [CI] 1.08–1.17) and experiencing barriers to healthcare (AOR = 1.64, 95% CI 1.34–2.01) were more likely to report difficulty taking ART. Patients less likely to report satisfaction with their HIV physician (AOR = 0.76, 95% CI 0.58–1.00) and achieve a non-detectable HIV viral load (AOR = 0.62, 95% CI 0.51–0.74) were more likely to report finding ART hard to take. In this community-recruited cohort of ART-exposed illicit drug users, a substantial proportion reported they found HIV treatment hard to take, which was clearly linked to higher dissatisfaction with healthcare experiences and, most importantly, a lower likelihood of experiencing optimal virologic outcomes. Our findings reveal a number of opportunities to improve HIV treatment experiences and outcomes for people who use illicit drugs, including the use of treatment regimens with lower pill burdens, as well as reducing barriers to healthcare access.
| Original language | English |
|---|---|
| Pages (from-to) | 1250-1257 |
| Number of pages | 8 |
| Journal | AIDS and Behavior |
| Volume | 23 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - May 15 2019 |
| Externally published | Yes |
Bibliographical note
Funding Information:Funding The study is supported by the US National Institutes of Health (R01-DA021525). The funders had no role in the design and conduct of this study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Dr. Milloy is supported in part by the US National Institutes of Health (R01-DA021525), a Scholar Award from the Michael Smith Foundation for Health Research and a New Investigator Award from the Canadian Institutes of Health Research. His institution has received an unstructured gift from NG Biomed Ltd. to support his research. Dr. Montaner is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (No. 1DP1DA026182) from the National Institute of Drug Abuse, at the US National Institutes of Health. He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief (PEPfAR), UNICEF, the University of British Columbia, Simon Fraser University, Providence
Funding Information:
Conflict of interest Dr. Milloy is supported in part by the US National Institutes of Health (R01-DA021525), a Scholar Award from the Michael Smith Foundation for Health Research and a New Investigator Award from the Canadian Institutes of Health Research. His institution has received an unstructured gift from NG Biomed Ltd. to support his research. Dr. Montaner is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (No. 1DP1DA026182) from the National Institute of Drug Abuse, at the US National Institutes of Health. He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief (PEPfAR), UNICEF, the University of British Columbia, Simon Fraser University, Providence Health Care and Vancouver Coastal Health Authority. Dr. Socias is supported by a Michael Smith Foundation for Health Research (MSFHR) post-doctoral fellowship award and a Canada Addiction Medicine Research Fellowship from NIDA at the NIH (R25-DA037756). All other authors declare no conflicts of interest.
Funding Information:
Health Care and Vancouver Coastal Health Authority. MES is supported by a Michael Smith Foundation for Health Research (MSFHR) post-doctoral fellowship award and a Canada Addiction Medicine Research Fellowship from NIDA at the NIH (R25-DA037756). This study was funded by the United States National Institutes of Health (U01-DA02515215).
Publisher Copyright:
© 2018, Springer Science+Business Media, LLC, part of Springer Nature.
ASJC Scopus Subject Areas
- Social Psychology
- Public Health, Environmental and Occupational Health
- Infectious Diseases
