title: Factors associated with initiation of antiretroviral therapy among HIV-positive people who use injection drugs in a Canadian setting.
abstract: OBJECTIVE
  To identify behavioral, social, and structural factors associated with time from HIV seroconversion to antiretroviral therapy (ART) initiation among people who use injection drugs (PWID).
  
  
  METHODS
  Two complementary prospective cohorts of PWID linked to comprehensive ART dispensation records in a setting of universal no-cost HIV/AIDS treatment and care.
  
  
  METHODS
  Multivariable extended Cox models of time to ART initiation among baseline HIV-seronegative PWID who seroconverted after recruitment adjusted with a time-updated measure of clinical eligibility for ART.
  
  
  RESULTS
  We included 133 individuals of whom 98 (74%) initiated ART during follow-up at a rate of 12.4 per 100 person-years. In a multivariable model adjusted for ART eligibility, methadone maintenance therapy [adjusted hazard ratio (AHR) = 2.37, 95% confidence interval (95% CI): 1.56-3.60] and a more recent calendar year of observation (AHR = 1.06, 95% CI: 1.00-1.12) were associated with more rapid ART initiation, whereas informal income generation (AHR = 0.51, 95% CI: 0.32-0.79) and incarceration (AHR = 0.52, 95% CI: 0.28-0.97) were negatively associated with ART initiation.
  
  
  CONCLUSIONS
  In this sample of community-recruited HIV-positive PWID with well defined dates of HIV seroconversion, we found that two measures related to the criminalization of illicit drug use each independently delayed ART initiation regardless of clinical eligibility. Engagement in methadone promoted ART initiation. Programs to scale-up HIV treatment among PWID should consider decreased criminalization of PWID and increased access to opioid substitution therapy to optimize the impact of ART on HIV/AIDS-associated morbidity, mortality, and HIV transmission.
authors.affiliation: aBritish Columbia Centre for Excellence in HIV/AIDS bDepartment of Medicine cDepartment of Sociology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Brenden
authors.initials: B
authors.lastname: Joseph
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Kanna
authors.initials: K
authors.lastname: Hayashi
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Rolando
authors.initials: R
authors.lastname: Barrios
authors.forename: Surita
authors.initials: S
authors.lastname: Parashar
authors.forename: Lindsey
authors.initials: L
authors.lastname: Richardson
authors.forename: Sabina
authors.initials: S
authors.lastname: Dobrer
authors.forename: Silvia
authors.initials: S
authors.lastname: Guillemi
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D002170:Canada; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology*; D013997:Time Factors
chemical_list: D044966:Anti-Retroviral Agents