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- Title
The effect of engagement in an HIV/ AIDS integrated health programme on plasma HIV-1 RNA suppression among HIV-positive people who use illicit drugs: a marginal structural modelling analysis.
- Authors
Ti, L; Dong, H; Kerr, T; Turje, RB; Parashar, S; Min, JE; Montaner, J; Wood, E; Milloy, M‐J
- Abstract
Objectives HIV treatment-as-prevention campaigns emphasize early diagnosis and immediate access to care and antiretroviral therapy for HIV-positive individuals in order to increase levels of plasma HIV RNA viral load ( VL) suppression. However, the possible role of harm reduction-based programmes in this objective has not yet been well evaluated. The objective of the study was to examine the relationship between being a client of the Dr. Peter Centre ( DPC; an HIV/ AIDS-focused adult integrated health programme) and VL suppression among highly active antiretroviral therapy ( HAART)-exposed HIV-positive people who use illicit drugs ( PWUD) in Vancouver, Canada. Methods Data were derived from the AIDS Care Cohort to Evaluate Exposure to Survival Services ( ACCESS) study, a study of a community-recruited cohort of HIV-positive PWUD. A marginal structural model using inverse probability of treatment weights was used to estimate the longitudinal relationship between being a DPC client and exhibiting a VL < 50 HIV-1 RNA copies/mL plasma. Results Between 2005 and 2014, 746 HAART-exposed participants were included in the study, of whom 269 (36.1%) reported being a DPC client at some time during the study period. A marginal structural model estimated a 1.54 greater odds of achieving VL suppression (95% confidence interval 1.20-1.99) among DPC clients. Conclusions Our findings demonstrate that participating in an innovative HIV/ AIDS-focused adult integrated health programme that provides a broad range of clinical, harm reduction, and support services may contribute to optimizing the benefits of HAART in terms of morbidity, mortality and viral transmission among PWUD, and as a result help to fulfill the goals of the treatment-as-prevention strategy.
- Subjects
CANADA; HIV prevention; PREVENTIVE medicine; MORTALITY prevention; PREVENTION of infectious disease transmission; ANTI-HIV agents; CONFIDENCE intervals; DRUGS of abuse; HIV infections; HIV-positive persons; LONGITUDINAL method; STRUCTURAL models; VIRAL load; HARM reduction; HIGHLY active antiretroviral therapy; EVALUATION of human services programs; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio
- Publication
HIV Medicine, 2017, Vol 18, Issue 8, p580
- ISSN
1464-2662
- Publication type
Article
- DOI
10.1111/hiv.12493