Longitudinal correlates of health care-seeking behaviors among HIV-seropositive injection drug users: How can we intervene to improve health care utilization?

OBJECTIVE: To identify modifiable factors associated with health care utilization by HIV-negative seropositive injection drug users (IDUs). METHODS: We analyzed longitudinal data from 966 participants in a randomized controlled trial of a behavioral intervention designed to address medical care, adherence, and risk reduction. The outcomes of this study were usual place for care (clinic vs. emergency room) and frequency of primary care visits. RESULTS: Results of multiple logistic regression analysis showed that increase in "importance of HIV care scale" score (odds ratio [OR] = 2.99; P < 0.001), empowerment (OR = 3.53; P < 0.001), utilization of case management (OR = 3.07; P = 0.007), and having a stable residence (OR = 2.63; P = 0.008) were significantly associated with participants being "clinic users." Increase in importance of HIV care scale score (OR = 5.65; P = 0.01) increased empowerment (OR = 2.42; P = 0.005), taking greater control of one's health (OR = 2.17; P = 0.001), having health insurance (OR = 2.58; P = 0.003), utilization of case management (OR = 3.14; P = 0.027), and CD4 count ≥200 cells/mm (OR = 2.09; P = 0.007) were significantly associated with reporting 2 or more primary HIV care visits in the past 6 months. CONCLUSIONS: Future interventions for this population may be strengthened by addressing the importance of HIV primary care; empowering participants with respect to the health care system; and promoting linkages to case management, health insurance, and local housing programs.