Individual, Interpersonal, and Structural Correlates of Effective HAART Use Among Urban Active Injection Drug Users

Abstract

Among individuals receiving highly active antiretroviral therapy (HAART), injection drug users (IDUs) are less likely to achieve HIV suppression. The present study examined individual-level, interpersonal, and structural factors associated with achieving undetectable plasma viral load (UVL) among US IDUs receiving recommended HAART. Data were from baseline assessments of the INSPIRE (Interventions for Seropositive Injectors-Research and Evaluation) study, a 4-site, secondary HIV prevention intervention for heterosexually active IDUs. Of 1113 study participants at baseline, 42% (n = 466) were currently taking recommended HAART (34% were female, 69% non-Hispanic black, 26% recently homeless; median age was 43 years), of whom 132 (28%) had a UVL. Logistic regression revealed that among those on recommended HAART, adjusted odds of UVL were at least 3 times higher among those with high social support, stable housing, and CD4 > 200; UVL was approximately 60% higher among those reporting better patient-provider communication. Outpatient drug treatment and non-Hispanic black race and an interaction between current drug use and social support were marginally negatively significant. Among those with high perceived support, noncurrent drug users compared with current drug users had a greater likelihood of UVL; current drug use was not associated with UVL among those with low support. Depressive symptoms (Brief Symptom Inventory) were not significant. Results suggest the major role of social support in facilitating effective HAART use in this population and suggest that active drug use may interfere with HAART use by adversely affecting social support. Interventions promoting social support functioning, patient-provider communication, stable housing, and drug abuse treatment may facilitate effective HAART use in this vulnerable population.

Adherence to Antiretroviral Therapy Among HIV-Infected Drug Users: A Meta-Analysis

“…Eight studies assessed optimal adherence as greater than 95% (Escobar et al 2003;Kerr et al 2004;Knowlton et al 2006;Palepu et al 2004bPalepu et al , 2006Turner et al 2003;Wood et al 2003bWood et al , 2004b. Three studies used adherence greater than 90% (Arnsten et al 2007;Gordillo et al 1999;Hinkin et al 2007); eight as greater than 80% (Altice et al 2001;Avants et al 2001;Bouhnik et al 2002Bouhnik et al , 2005Carrieri et al 2003a;Clarke et al 2003;Duran et al 2001;Moatti et al 2000); and one study as greater than 75% of prescribed medicines (Altice et al 2004).…”

Differential Predictors of Medication Adherence in HIV: Findings from a Sample of African American and Caucasian HIV-Positive Drug-Using Adults

“…12 A study of injection drug users with HIV/AIDS identified both structural (stable housing, medical coverage) and individual (patient-provider engagement, more HIV primary care visits, not currently using drugs, and a positive attitude about ART benefits) predictors of medication adherence at a 6-month follow-up. 13 In a qualitative study of 80 seropositive African Americans on ART, variations in rationales for explaining adherence were identified, suggesting heterogeneity within the African American culture regarding reasons for adherence.…”

Depression and social context: primary supporter relationship factors associated with depressive symptoms among a disadvantaged population with HIV/AIDS

“…Among those living with HIV/AIDS, depressive symptoms as well as low levels of social support have been found to interfere with HIV treatment adherence and contribute to worse HIV health outcomes (Knowlton et al, 2006;Moore, Keruly, & Chaisson, 2004). Prior studies suggest that depressive symptoms may be associated with strains in main supportive relationships, and that this stress may threaten the effectiveness or continuity of needed support (Douglass, 1997;Kahana & Young, 1990;Newsom, 1999;Schrimshaw, 2002).…”