title: Dose-response effect of incarceration events on nonadherence to HIV antiretroviral therapy among injection drug users.
abstract: BACKGROUND
  Although some studies have identified impressive clinical gains for incarcerated HIV-seropositive injection drug users (IDUs) undergoing antiretroviral therapy (ART), the effect of incarceration on adherence to ART remains undetermined.
  
  
  METHODS
  We used data from a long-term community-recruited cohort of HIV-seropositive IDUs, including comprehensive ART dispensation records, in a setting where HIV care is free. We estimated the relationship between the cumulative burden of incarceration, measured longitudinally, and the odds of < 95% adherence to ART, with use of multivariate modeling.
  
  
  RESULTS
  From 1996 through 2008, 490 IDUs were recruited and contributed 2220 person-years of follow-up; 271 participants (55.3%) experienced an incarceration episode, with the number of incarcerations totaling 1156. In a multivariate model, incarceration had a strong dose-dependent effect on the likelihood of nonadherence to ART: 1-2 incarceration events (adjusted odds ratio [AOR], 1.49; 95% confidence interval [95% CI], 1.03-2.05), 3-5 events (AOR, 2.48; 95% CI, 1.62-3.65), and > 5 events (AOR, 3.11; 95% CI, 1.86-4.95).
  
  
  CONCLUSIONS
  Among HIV-seropositive IDUs receiving ART, an increasing burden of incarceration was associated with poorer adherence in a dose-dependent fashion. Our findings support improved adherence support for HIV-seropositive IDUs experiencing incarceration.
authors: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
authors: M J
authors: MJ
authors: Milloy
authors: Thomas
authors: T
authors: Kerr
authors: Jane
authors: J
authors: Buxton
authors: Tim
authors: T
authors: Rhodes
authors: Silvia
authors: S
authors: Guillemi
authors: Robert
authors: R
authors: Hogg
authors: Julio
authors: J
authors: Montaner
authors: Evan
authors: E
authors: Wood
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011330:Prisons; D015819:Substance Abuse, Intravenous; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents