Out-patient medical care in Edinburgh for IDU-related HIV.
Using combined medical and drug clinics, by the end of 1990 we had initiated contact with 511 HIV positive individuals, 75% injection drug use (IDU) related. We have previously reported a significant reduction in the number of missed appointments from 1985-89 following the introduction of methadone and an all day clinic, but between 1989 and 1990 the appointment default rate rose from 17 to 25%. A significant percentage increase in missed appointments was, however, only seen in those not attending the all day clinic (chi 2(3) = 121.3, p < 0.001). An analysis of the patients missing appointments during 1989-90 revealed that 36-45% of patients attending each year missed only 1 or 2 appointments, that the majority of missed appointments each year were accounted for by less than 20% of the patients, around 60% of these patients missed appointments in both years and that only 2% of patients attending both years consistently miss 3 or more appointments per year. Laboratory monitoring of HIV, that is at least one sampling episode in a year, was achieved, however, in 92-95% of the patients attending each year. The annual number of patients lost to follow-up varied between 7 and 11% per year, but did not change significantly over time, whilst the cumulative number of HIV infected individuals lost to follow-up after 5 years was only 14%. Between 1986 and 1990 self-reported reduction in IDU was more likely in HIV positive than negative individuals; the number of HIV positive individuals who reported injecting for more than 50% of the year fell from 40 to 5% (chi 2(4) = 15.23, p < 0.01) whilst the number who reported at least one injection per year fell from 51 to 23% (chi 2(4) = 62.06, p < 0.001). By comparison amongst non-HIV-infected patients the percentage who reported opiate use for more than 50% of the visits during a year rose from 54% in 1986 to a peak of 70% in 1989 (chi 2(4) = 10.22, p < 0.05) and those who reported opiate use at least once during the year rose from 57% in 1986 to a peak of 75% in 1989 (chi 2(4) = 14.3, p = 0.006). Combined medical and drug clinics from 1986 to 1990 together with a multi-disciplinary team approach to medical care was successful in delivering health care to HIV-infected injection drug users.(ABSTRACT TRUNCATED AT 400 WORDS)
Brettle
R P
RP
Regional Infectious Disease Unit, City Hospital, Edinburgh, UK.
Willocks
L
L
Hamilton
B A
BA
Shaw
L
L
Leen
C L
CL
Richardson
A
A
Gore
S M
SM
D000553:Ambulatory Care / Q000706:statistics & numerical data; D001071:Appointments and Schedules; D003131:Combined Modality Therapy; D015658:HIV Infections / Q000534:rehabilitation* / Q000635:transmission; D015438:Health Behavior; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012606:Scotland; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000534:rehabilitation*
D008691:Methadone