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Author Notes:

Address correspondence to: Rupali Kotwal Doshi, Emory University School of Medicine, Division of Infectious Diseases, 49 Jesse Hill Jr. Drive, Atlanta, Georgia 30303. Email: rkdoshi@emory.edu

Rupali Kotwal Doshi and Nicholas Vogenthaler contributed equally to this work.

We thank our study participants, Lauren Gooden, Tamy Kuper, Gabriel Cardenas, and the Atlanta and Miami Project HOPE study teams.

No competing financial interests exist.

Subjects:

Research Funding:

This study was supported in part by the National Institutes of Health (NIH) and NIDA (R01 DA01761201A2), NIH/NIAID Emory CFAR (2P30AI050409), University of Miami D-CFAR (P30AI073961), and NIH/NCRR (PHS grant UL RR025008).

Correlates of Antiretroviral Utilization Among Hospitalized HIV-Infected Crack Cocaine Users

Tools:

Journal Title:

AIDS Research and Human Retroviruses

Volume:

Volume 28, Number 9

Publisher:

, Pages 1007-1014

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Despite the availability of antiretroviral therapy (ART), HIV-infected drug users, particularly crack cocaine users, continue to have high HIV-related morbidity and mortality. We conducted a cross-sectional analysis of the baseline data for hospitalized HIV-infected crack cocaine users recruited for Project HOPE (Hospital Visit Is an Opportunity for Prevention and Engagement with HIV-Positive Crack Users) in Atlanta and Miami who were eligible for ART (reported any lifetime use of ART or CD4 <350 cells/μl). Among 350 eligible participants, whose mean age was 44.9 years (SD 7.0), 49% were male, 90% were black, and 81% were heterosexual. The median CD4 count was 144 cells/μl, and 78 of 350 (22%) were taking ART. We conducted a multivariable logistic regression to examine individual, interpersonal, and structural factors as potential correlates of ART use. Reporting ≥2 visits to outpatient HIV care in the past 6 months (AOR 7.55, 95% CI 3.80–14.99), drug or alcohol treatment in the past 6 months (AOR 2.29, 95% CI 1.06–4.94), and study site being Miami (AOR 2.99, 95% CI 1.56–5.73) were associated with ART use. Current homelessness (AOR 0.41, 95% CI 0.20–0.84) and CD4 <200 cells/μl (AOR 0.29, 95% CI 0.15–0.55) were negatively associated with ART use. Among those taking ART, 60% had an HIV-1 viral load <400 copies/ml; this represented 9% of the eligible population. For HIV-infected crack cocaine users, structural factors may be as important as individual and interpersonal factors in facilitating ART utilization. Few HIV+ crack cocaine users had viral suppression, but among those on ART, viral suppression was achievable.

Copyright information:

© 2012 Mary Ann Liebert, Inc.

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