title: Contribution of substance use disorders on HIV treatment outcomes and antiretroviral medication adherence among HIV-infected persons entering jail.
abstract: HIV and substance use are inextricably intertwined. One-sixth of people living with HIV/AIDS (PLWHA) transition through the correctional system annually. There is paucity of evidence on the impact of substance use disorders on HIV treatment engagement among jail detainees. We examined correlates of HIV treatment in the largest sample of PLWHA transitioning through jail in 10 US sites from 2007 to 2011. Cocaine, alcohol, cannabis, and heroin were the most commonly used substances. Drug use severity was negatively and independently correlated with three outcomes just before incarceration: (1) having an HIV care provider (AOR = 0.28; 95 % CI 0.09-0.89); (2) being prescribed antiretroviral therapy (AOR = 0.12; 95 % CI 0.04-0.35) and (3) high levels (>95 %) of antiretroviral medication adherence (AOR = 0.18; 95 % CI 0.05-0.62). Demographic, medical and psychiatric comorbidity, and social factors also contributed to poor outcomes. Evidence-based drug treatments that include multi-faceted interventions, including medication-assisted therapies, are urgently needed to effectively engage this vulnerable population.
authors.affiliation: Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510-2283, USA.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Chitsaz
authors.forename: Jaimie P
authors.initials: JP
authors.lastname: Meyer
authors.forename: Archana
authors.initials: A
authors.lastname: Krishnan
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Springer
authors.forename: Ruthanne
authors.initials: R
authors.lastname: Marcus
authors.forename: Nick
authors.initials: N
authors.lastname: Zaller
authors.forename: Alison O
authors.initials: AO
authors.lastname: Jordan
authors.forename: Thomas
authors.initials: T
authors.lastname: Lincoln
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Flanigan
authors.forename: Jeff
authors.initials: J
authors.lastname: Porterfield
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology / Q000821:virology; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011330:Prisons; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology; D019966:Substance-Related Disorders / Q000150:complications* / Q000523:psychology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents