Longitudinal changes in engagement in care and viral suppression for HIV-infected injection drug users

Ryan P. Westergaard, Timothy Hess, Jacquie Astemborski, Shruti H. Mehta, Gregory D. Kirk

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To examine temporal trends and predictors of linkage to HIV care, longitudinal retention in care and viral suppression among injection drug users (IDUs) infected with HIV. DESIGN: Community-based, prospective cohort study. METHODS: We prospectively studied 790 HIV-infected IDUs participating in the AIDS Linked to the Intravenous Experience (ALIVE) study from 1998 through 2011. IDUs were considered linked to care if they attended any HIV care visit during follow-up and retained in care if they reported HIV clinic attendance at every semi-annual study visit. We used logistic regression to identify predictors of poor retention in care and failure to achieve sustained viral suppression in response to ART. RESULTS: Of 790 HIV-infected IDUs studied, 740 (93.6%) were ever linked to care. The majority of IDUs (76.7%) received ART at some point during observation and of these, most (85.4%) achieved viral suppression. However, over a median of 8.7 years of follow-up, only 241 (30.5%) IDUs were continuously retained with no 6-month lapses in HIV care and only 63 (10.2%) had sustained viral suppression at every study visit after first receiving ART. Suboptimal engagement in care was associated with poor access to medical care, active drug use, and incarceration. CONCLUSION: Compared with national estimates of retention in care and virologic suppression in the United States, IDUs are substantially less likely to remain fully engaged in HIV care. Strategies to optimize HIV care should acknowledge the elevated risk of poor engagement in care among IDUs.

Original languageEnglish (US)
Pages (from-to)2559-2566
Number of pages8
JournalAIDS
Volume27
Issue number16
DOIs
StatePublished - Oct 23 2013

Keywords

  • antiretroviral therapy
  • drug users
  • human immunodeficiency virus
  • primary care
  • retention in care

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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