Article

Impact of HIV testing on uptake of HIV therapy among antiretroviral naive HIV-infected injection drug users

Department of Family and Preventive Medicine, University of California, San Diego, San Diego, California, United States
Drug and Alcohol Review (Impact Factor: 1.55). 10/2006; 25(5):451-4. DOI: 10.1080/09595230600883313
Source: PubMed

ABSTRACT

Improving access to antiretroviral therapy among injection drug users remains an urgent public health concern. We examined the time to antiretroviral therapy (ART) use among antiretroviral naive HIV-infected injection drug users who were unaware of their HIV status to examine the impact of receipt of HIV test results on uptake of ART. Time to ART use was examined using Kaplan - Meier methods, and factors associated with the time to ART were evaluated using Cox proportional hazards regression. Between May 1996 and May 2003, 312 HIV-infected individuals were enrolled into the Barriers to Antiretroviral Therapy (BART) cohort, among whom 105 (33.7%) reported not knowing their HIV status at baseline. At 24 months post-baseline, those participants who returned for test results within 8 months initiated ART at a significantly elevated rate [adjusted relative hazard = 1.87 (95% CI: 1.05 - 3.33)]. These findings demonstrate the potential to improve uptake of ART among injection drug users through targeted HIV testing and counselling initiatives that encourage the receipt of HIV test results, and suggest that strategies to improve awareness of HIV infection may improve access to antiretroviral therapy.

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    • "According to the Ministry of Public Health Thailand, the prevalence of HIV among this population remains high (between 30 and 50 %), while the prevalence of HIV in other high-risk groups, such as commercial sex workers and pregnant women, has been declining steadily over recent years [1]. To minimize the morbidity and mortality associated with HIV, many international health organizations are urging countries to scale up their voluntary HIV counseling and testing services (VCT) for IDU [2, 3], as testing can lead to the identification of undiagnosed HIV infection and early treatment [4–6]. In addition to linking IDU to proper healthcare services, knowledge of HIV serostatus may also have success in reducing HIV risk behavior among this population [7]. "
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    ABSTRACT: Peer-based models for human immunodeficiency virus (HIV) testing have been implemented to increase access to testing in various settings. However, little is known about the acceptability of peer-delivered testing and counseling among people who inject drugs (IDU). During July and October 2011, data derived from the Mitsampan Community Research Project were used to construct three multivariate logistic regression models identifying factors associated with willingness to receive peer-delivered pre-test counseling, rapid HIV testing, and post-test counseling. Among a total of 348 IDU, 44, 38, and 36 % were willing to receive peer-delivered pre-test counseling, rapid HIV testing, and post-test counseling, respectively. In multivariate analyses, factors associated with willingness to access peer-delivered pre-test counseling included: male gender (adjusted odds ratio (AOR) = 0.48), higher than secondary education (AOR = 1.91), and binge drug use (AOR = 2.29) (all p < 0.05). Factors associated with willingness to access peer-delivered rapid HIV testing included: higher than secondary education (AOR = 2.06), binge drug use (AOR = 2.23), incarceration (AOR = 2.68), avoiding HIV testing (AOR = 0.24), and having been to the Mitsampan Harm Reduction Center (AOR = 1.63) (all p < 0.05). Lastly, binge drug use (AOR = 2.40), incarceration (AOR = 1.94), and avoiding HIV testing (AOR = 0.23) (all p < 0.05) were significantly associated with willingness to access peer-delivered post-test counseling. We found that a substantial proportion of Thai IDU were willing to receive peer-delivered HIV testing and counseling. These findings highlight the potential of peer-delivered testing to complement existing HIV testing programs that serve IDU.
    Preview · Article · Nov 2012 · Journal of Community Health
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    ABSTRACT: Achtergrond en doel: Drugsgebruikers (DG) zijn de grootste risicopopulatie voor besmetting met HCV. De Gemeente Gezondheidsdienst (GGD) van Amsterdam heeft het Drug Users Treatment for Chronic Hepatitis C (Dutch-C) project opgezet om DG te screenen en optimaal te kunnen behandelen. De doelen van deze studie waren (1) het begrijpen van de huidige en vroegere redenen waarom een deel van de DG behandeling geweigerd hebben en (2) redenen waarom DG uiteindelijk hebben toegestemd in behandeling. Deze informatie kan gebruikt worden voor verbetering van de HCV behandelingsmogelijkheden en de versterking van campagnes en overtuigende communicatie voor toekomstige inclusie in HCV behandeling bij DG. Methoden: Binnen dit onderzoek werd de kwalitatieve Grounded Theory (GT) methode gevolgd. Selectie van participanten vond plaats door middel van een doelgerichte steekproef uit de Dutch-C populatie. Dataverzameling vond plaats door middel van semigestructureerde interviews. De interviews werden opgenomen op band, getranscribeerd en geanalyseerd door middel van open codering. Interpretatie van data geschiedde volgens het Health Belief model. Resultaten: In totaal participeerden 22 DG in dit onderzoek. Gerapporteerde barrières waren verkeerde aannames over de ziekte, angst voor bijwerkingen, twijfel over de werkzaamheid van therapie, geen geloof in medische interventies, frustratie over communicatie tussen hulpverleners, kennistekort, ziekteontkenning en afwijzing van gezondheidszorginstantie. Motieven voor DG die behandeling gestart zijn waren het vermijden van negatieve lichamelijke consequenties gerelateerd aan HCV, zich beter willen voelen, vertrouwen in de organisatie of hulpverleners, het zien van de behandeling als kans en de invloed van andere mensen die behandeling volgen. Conclusie: Lage waargenomen bedreiging van de ziekte gebaseerd op verkeerde aannames over ziekte en behandeling, kennistekort en ziekteontkenning vormt veelal de basis voor weigeren van de behandeling. De kosten van de behandeling in de vorm van bijwerkingen worden als proportioneel hoog ervaren. Waargenomen vatbaarheid en ernst van de ziekte moeten verhoogd worden en kosten van de behandeling moeten verlaagd worden door middel van adequate voorlichting. Voor DG die behandeling in het verleden geweigerd hebben blijkt juist kennis over de gevolgen, ofwel hoge ervaren ernst en vatbaarheid voor de ziekte, een motief voor behandeling te zijn.
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    ABSTRACT: Many cities throughout the globe are experiencing ongoing infectious disease and overdose epidemics among injection drug users (IDUs). In particular, HIV has become endemic among IDUs in many settings. In an effort to reduce this and related public health concerns, medically supervised safer injecting facilities (SIFs), where IDUs can inject pre-obtained illicit drugs under the supervision of medical staff, have been established in several countries. The following review assesses the role that SIFs can play in reducing the harms associated with HIV infection among IDUs and points to ways in which SIFs can be further developed to better respond to the challenges associated with HIV/AIDS among this population.
    No preview · Article · Jan 2008 · Current HIV/AIDS Reports
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