title: Emergency department utilization among a cohort of HIV-positive injecting drug users in a Canadian setting.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-positive injection drug users (IDUs) are known to be at risk for multiple medical problems that may necessitate emergency department (ED) use; however, the relative contribution of HIV disease vs. injection-related complications has not been well described.
  
  
  OBJECTIVE
  We examined factors associated with ED use among a prospective cohort of HIV-positive IDUs in a Canadian setting.
  
  
  METHODS
  We enrolled HIV-positive IDUs into a community-recruited prospective cohort study. We modeled factors associated with the time to first ED visit using Cox regression to determine factors independently associated with ED use. In sub-analyses, we examined ED diagnoses and subsequent hospital admission rates.
  
  
  RESULTS
  Between December 5, 2005 and April 30, 2008, 428 HIV-positive IDUs were enrolled, among whom the cumulative incidence of ED use was 63.7% (95% confidence interval [CI] 59.1-68.3%) at 12 months after enrollment. Factors independently associated with time to first ED visit included: unstable housing (hazard ratio [HR] 1.5; 95% CI 1.1-2.0) and reporting being unable to obtain needed health care services (HR 2.2; 95% CI 1.2-4.1), whereas CD4 count and viral load were non-significant. Skin and soft tissue infections accounted for the greatest proportion of ED visits (17%). Of the 2461 visits to the ED, 419 (17%) were admitted to the hospital.
  
  
  CONCLUSIONS
  High rates of ED use were observed among HIV-positive IDUs, a behavior that was predicted by unstable housing and limited access to primary care. Factors other than HIV infection seem to be driving ED use among this population in the post-highly active antiretroviral therapy era.
authors: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors: Nadia
authors: N
authors: Fairbairn
authors: M-J
authors: MJ
authors: Milloy
authors: Ruth
authors: R
authors: Zhang
authors: Calvin
authors: C
authors: Lai
authors: Eric
authors: E
authors: Grafstein
authors: Thomas
authors: T
authors: Kerr
authors: Evan
authors: E
authors: Wood
mesh_terms: D000328:Adult; D001955:British Columbia; D018791:CD4 Lymphocyte Count; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data; D006798:Housing; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012874:Skin Diseases, Infectious / Q000175:diagnosis / Q000209:etiology*; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000209:etiology*; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013997:Time Factors; D019562:Viral Load