Factors Associated with Initiation of Antiretroviral Therapy among HIV-Positive People Who Use Injection Drugs in a Canadian Setting
OBJECTIVE:
To
identify behavioural, social and structural factors associated with time from
HIV seroconversion to antiretroviral therapy (ART) initiation among people who
use injection drugs (PWID).
DESIGN:
Two
complementary prospective cohorts of PWID linked to comprehensive ART
dispensation records in a setting of universal no-cost HIV/AIDS treatment and
care.
METHODS:
Multivariable
extended Cox models of time to ART initiation among baseline HIV-seronegative
PWID who seroconverted after recruitment adjusted with a time-updated measure
of clinical eligibility for ART.
RESULTS:
We
included 133 individuals of whom 98 (74%) initiated ART during follow-up at a
rate of 12.4 per 100 person-years. In a multivariable model adjusted for ART
eligibility, methadone maintenance therapy and a more recent calendar year of
observation were associated with more rapid ART
initiation, whereas informal income generation and incarceration were negatively associated
with ART initiation.
CONCLUSIONS:
In
this sample of community-recruited HIV-positive PWID with well-defined dates of
HIV seroconversion, we found that two measures related to the criminalization
of illicit drug use each independently delayed ART initiation regardless of
clinical eligibility. Engagement in methadone promoted ART initiation. Programs
to scale-up HIV treatment among PWID should consider decreased criminalization
of PWID and increased access to opioid substitution therapy in order to
optimize the impact of ART on HIV/AIDS-associated morbidity, mortality and HIV
transmission.
By: Joseph B1, Wood E, Hayashi K, Kerr T, Barrios R, Parashar S, Richardson L, Dobrer S, Guillemi S, Montaner J, Milloy MJ.
- 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6 bDepartment of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6 cDepartment of Sociology, University of British Columbia, Vancouver, BC, CANADA, V6T 1Z1.
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