TY - JOUR
T1 - Longitudinal changes in engagement in care and viral suppression for HIV-infected injection drug users
AU - Westergaard, Ryan P.
AU - Hess, Timothy
AU - Astemborski, Jacquie
AU - Mehta, Shruti H.
AU - Kirk, Gregory D.
PY - 2013/10/23
Y1 - 2013/10/23
N2 - 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.
AB - 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.
KW - antiretroviral therapy
KW - drug users
KW - human immunodeficiency virus
KW - primary care
KW - retention in care
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U2 - 10.1097/QAD.0b013e328363bff2
DO - 10.1097/QAD.0b013e328363bff2
M3 - Article
C2 - 23770493
AN - SCOPUS:84885425011
VL - 27
SP - 2559
EP - 2566
JO - AIDS
JF - AIDS
SN - 0269-9370
IS - 16
ER -