title: Individual, interpersonal, and structural correlates of effective HAART use among urban active injection drug users.
abstract: Among individuals receiving highly active antiretroviral therapy (HAART), injection drug users (IDUs) are less likely to achieve HIV suppression. The present study examined individual-level, interpersonal, and structural factors associated with achieving undetectable plasma viral load (UVL) among US IDUs receiving recommended HAART. Data were from baseline assessments of the INSPIRE (Interventions for Seropositive Injectors-Research and Evaluation) study, a 4-site, secondary HIV prevention intervention for heterosexually active IDUs. Of 1113 study participants at baseline, 42% (n = 466) were currently taking recommended HAART (34% were female, 69% non-Hispanic black, 26% recently homeless; median age was 43 years), of whom 132 (28%) had a UVL. Logistic regression revealed that among those on recommended HAART, adjusted odds of UVL were at least 3 times higher among those with high social support, stable housing, and CD4 > 200; UVL was approximately 60% higher among those reporting better patient-provider communication. Outpatient drug treatment and non-Hispanic black race and an interaction between current drug use and social support were marginally negatively significant. Among those with high perceived support, noncurrent drug users compared with current drug users had a greater likelihood of UVL; current drug use was not associated with UVL among those with low support. Depressive symptoms (Brief Symptom Inventory) were not significant. Results suggest the major role of social support in facilitating effective HAART use in this population and suggest that active drug use may interfere with HAART use by adversely affecting social support. Interventions promoting social support functioning, patient-provider communication, stable housing, and drug abuse treatment may facilitate effective HAART use in this vulnerable population.
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Knowlton
authors.forename: Julia
authors.initials: J
authors.lastname: Arnsten
authors.forename: Lois
authors.initials: L
authors.lastname: Eldred
authors.forename: James
authors.initials: J
authors.lastname: Wilkinson
authors.forename: Marc
authors.initials: M
authors.lastname: Gourevitch
authors.forename: Starley
authors.initials: S
authors.lastname: Shade
authors.forename: Krista
authors.initials: K
authors.lastname: Dowling
authors.forename: David
authors.initials: D
authors.lastname: Purcell
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006798:Housing; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010817:Physician-Patient Relations; D012944:Social Support; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016896:Treatment Outcome; D019562:Viral Load