Pilot study to enhance HIV care using needle exchange-based health services for out-of-treatment injecting drug users |
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Authors: | Altice Frederick L Springer Sandra Buitrago Marta Hunt David P Friedland Gerald H |
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Institution: | (1) Yale University AIDS Program, 135 College Street, Suite 323, 06510 New Haven, CT |
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Abstract: | The introduction of highly active antiretroviral therapy (HAART) has resulted in marked reductions in mortality and acquired
immunodeficiency syndrome (AIDS) incidence across all risk groups; however, the proportionate decrease among injecting drug
users (IDUs) has been less impressive. Much of the disparity in benefit to IDUs has been a consequence of decreased access
to and receipt of potent antiretroviral combinations. Strategies to increase access to and utilization of HAART have included
entry into drug treatment and abstinence. Unfortunately, as few as 15%–20% of active drug users in the United States, and
in many other countries, are in drug treatment at any one time. We report a pilot project among out-of-drug treatment IDUs
infected with human immunodeficiency virus (HIV); HIV therapy was successfully provided to active heroin injectors using the
Community Health Care Van (CHCV) at sites of needle exchange. Subjects were willing to initiate, but were not receiving, recommended
HIV therapy and were not interested in formal drug treatment. Antiretroviral therapy regimens were selected and linked to
heroin injection timing. Weekly visits were scheduled by CHCV staff to assess adverse side effects and encourage adherence.
Of the 13 participants, the mean baseline HIV-1 RNA level and CD4 lymphocyte count were 162,369 (log 5.21) copies per milliliter
and 265 cells per milliliter, respectively. By 6 months, the proportion whose HIV-1 RNA was below the limits of detection
(<400 copies/mL) was 85% (N=11); 77% (N=10) had nondetectable levels by 9 months. By 12 months, 54% (N=7) had a persistently
nondetectable viral load, and the net increase in CD4 lymphocyte count was 150 cells per milliliter. As an additional and
unintended benefit of this pilot project, 9 (69%) subjects chose to enter drug treatment after achieving a nondetectable viral
load. Entry into drug treatment was associated with durability of viral suppression. This small pilot study suggests that
health services based on needle exchange may enhance access to HAART among out-of-treatment HIV-infected IDUs. In addition,
it demonstrates that this population can benefit from this therapy with the support of a nontraditional, community-based health
intervention. |
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Keywords: | Adherence Antiretroviral therapy Directly observed therapy Health care Injecting drug users Intervention HIV/AIDS HIV therapeutics Needle exchange Substance abuse Substance abuse treatment |
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