title: Longitudinal changes in engagement in care and viral suppression for HIV-infected injection drug users.
abstract: OBJECTIVE
  To examine temporal trends and predictors of linkage to HIV care, longitudinal retention in care and viral suppression among injection drug users (IDUs) infected with HIV.
  
  
  METHODS
  Community-based, prospective cohort study.
  
  
  METHODS
  We prospectively studied 790 HIV-infected IDUs participating in the AIDS Linked to the Intravenous Experience (ALIVE) study from 1998 through 2011. IDUs were considered linked to care if they attended any HIV care visit during follow-up and retained in care if they reported HIV clinic attendance at every semi-annual study visit. We used logistic regression to identify predictors of poor retention in care and failure to achieve sustained viral suppression in response to ART.
  
  
  RESULTS
  Of 790 HIV-infected IDUs studied, 740 (93.6%) were ever linked to care. The majority of IDUs (76.7%) received ART at some point during observation and of these, most (85.4%) achieved viral suppression. However, over a median of 8.7 years of follow-up, only 241 (30.5%) IDUs were continuously retained with no 6-month lapses in HIV care and only 63 (10.2%) had sustained viral suppression at every study visit after first receiving ART. Suboptimal engagement in care was associated with poor access to medical care, active drug use, and incarceration.
  
  
  CONCLUSIONS
  Compared with national estimates of retention in care and virologic suppression in the United States, IDUs are substantially less likely to remain fully engaged in HIV care. Strategies to optimize HIV care should acknowledge the elevated risk of poor engagement in care among IDUs.
authors.affiliation: aDepartments of Medicine and Population Health Sciences bDepartment of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin cDepartment of Epidemiology dDepartments of Medicine, Epidemiology and Oncology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Westergaard
authors.forename: Timothy
authors.initials: T
authors.lastname: Hess
authors.forename: Jacquie
authors.initials: J
authors.lastname: Astemborski
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications*; D014481:United States; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents