Uptake and adherence to highly active antiretroviral therapy among HIV-infected people with alcohol and other substance use problems: the impact of substance abuse treatment.
OBJECTIVE
We examined the association of substance abuse treatment with uptake, adherence and virological response to highly active antiretroviral therapy (HAART) among HIV-infected people with a history of alcohol problems.


METHODS
Prospective cohort study.


METHODS
A standardized questionnaire was administered to 349 HIV-infected participants with a history of alcohol problems regarding demographics, substance use, use of substance abuse treatment and uptake of and adherence to HAART. These subjects were followed every 6 months for up to seven occasions. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half-way house or residential facility; 12 visits to a substance abuse counselor or mental health professional; or participation in any methadone maintenance program. Our outcome variables were uptake of antiretroviral therapy, 30-day self-reported adherence and HIV viral load suppression.


RESULTS
At baseline, 59% (205/349) of subjects were receiving HAART. Engagement in substance abuse treatment was independently associated with receiving antiretroviral therapy (adjusted OR; 95% CI: 1.70; 1.03-2.83). Substance abuse treatment was not associated with 30-day adherence or HIV viral load suppression. More depressive symptoms (0.48; 0.32-0.78) and use of drugs or alcohol in the previous 30 days (0.17; 0.11-0.28) were associated with worse 30-day adherence. HIV viral load suppression was positively associated with higher doses of antiretroviral medication (1.29; 1.15-1.45) and older age (1.04; 1.00-1.07) and negatively associated with use of drugs or alcohol in the previous 30 days (0.51; 0.33-0.78).


CONCLUSIONS
Substance abuse treatment was associated with receipt of HAART; however, it was not associated with adherence or HIV viral load suppression. Substance abuse treatment programs may provide an opportunity for HIV-infected people with alcohol or drug problems to openly address issues of HIV care including enhancing adherence to HAART.
Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. anita@hivnet.ubc.ca
Anita
A
Palepu
Nicholas J
NJ
Horton
Nicole
N
Tibbetts
Seville
S
Meli
Jeffrey H
JH
Samet
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000150:complications / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D019562:Viral Load