TY - JOUR
T1 - Needle-exchange attendance and health care utilization promote entry into detoxification
AU - Strath Dee, Steffanie A.
AU - Celentano, David D.
AU - Shah, Nina
AU - Lyles, Cynthia
AU - Stambolis, Veronica A.
AU - Macalino, Grace
AU - Nelson, Kenrad
AU - Vlahov, David
N1 - Funding Information:
This study was supported by the National Institute on Drug Abuse through grants DA04334 and DA08009. We gratefully acknowledge technical assistance from Jacqueline Astemborski, Lisette Johnson, Victoria Kanecko, Paul Gentille, and Robert Schwartz for critical review of the manuscript; staff from the Baltimore
PY - 1999/12
Y1 - 1999/12
N2 - This study was undertaken to identify factors associated with entry into detoxification among injection drug users (IDUs), and to assess the role of needle-exchange programs (NEPs) as a bridge to treatment. 1DUs undergoing semiannual human immunodeficiency virus (HIV) tests and interviews were studied prospectively between 1994 and 1998, during which time an NEP was introduced in Baltimore. Logistic regression was used to identify independent predictors of entry into detoxification, stratifying by HIV serostatus. Of 1,490 IDUs, similar proportions of HIV-infected and uninfected IDUs entered detoxification (25% vs. 23%, respectively). After accounting for recent drug use, hospital admission was associated with four-fold increased odds of entering detoxification for HIV-seronegative subjects. Among HIV-infected subjects, hospital admission, outpatient medical care, and having health insurance independently increased the odds of entering detoxification. After accounting for these and other variables, needle-exchange attendance also was associated independently with entering detoxification for both HIV-infected (adjusted odds ratio [AOR] = 3.2) and uninfected IDUs (AOR = 1.4). However, among HIV-infected subjects, the increased odds of detoxification associated with needle exchange diminished significantly over time, concomitant with statewide reductions in detoxification admissions. These findings indicate that health care providers and NEPs represent an important bridge to drug abuse treatment for HIV-infected and uninfected IDUs. Creating and sustaining these linkages may facilitate entry into drug abuse treatment and serve the important public health goal of increasing the number of drug users in treatment.
AB - This study was undertaken to identify factors associated with entry into detoxification among injection drug users (IDUs), and to assess the role of needle-exchange programs (NEPs) as a bridge to treatment. 1DUs undergoing semiannual human immunodeficiency virus (HIV) tests and interviews were studied prospectively between 1994 and 1998, during which time an NEP was introduced in Baltimore. Logistic regression was used to identify independent predictors of entry into detoxification, stratifying by HIV serostatus. Of 1,490 IDUs, similar proportions of HIV-infected and uninfected IDUs entered detoxification (25% vs. 23%, respectively). After accounting for recent drug use, hospital admission was associated with four-fold increased odds of entering detoxification for HIV-seronegative subjects. Among HIV-infected subjects, hospital admission, outpatient medical care, and having health insurance independently increased the odds of entering detoxification. After accounting for these and other variables, needle-exchange attendance also was associated independently with entering detoxification for both HIV-infected (adjusted odds ratio [AOR] = 3.2) and uninfected IDUs (AOR = 1.4). However, among HIV-infected subjects, the increased odds of detoxification associated with needle exchange diminished significantly over time, concomitant with statewide reductions in detoxification admissions. These findings indicate that health care providers and NEPs represent an important bridge to drug abuse treatment for HIV-infected and uninfected IDUs. Creating and sustaining these linkages may facilitate entry into drug abuse treatment and serve the important public health goal of increasing the number of drug users in treatment.
KW - Detoxification
KW - HIV/AIDS
KW - Injection drug use
KW - Needle-exchange Programs
KW - Substance abuse treatment
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U2 - 10.1007/BF02351502
DO - 10.1007/BF02351502
M3 - Article
C2 - 10609594
AN - SCOPUS:0032734207
VL - 76
SP - 448
EP - 460
JO - Bulletin of the New York Academy of Medicine
JF - Bulletin of the New York Academy of Medicine
SN - 1099-3460
IS - 4
ER -