title: Recruitment, Follow-Up and Characteristics of HIV Infected Adults who Use Illicit Drugs in Southern Africa.
abstract: BACKGROUND
  With one of the worst HIV prevalence rates in the world, Botswana has made great strides in addressing AIDS. Nevertheless, to fully contain the epidemic, outreach to marginalized groups, including illicit drug users, is critical.
  
  
  OBJECTIVE
  To conduct targeted outreach within an intervention trial to recruit HIV-infected drug users and assess HIV disease and nutritional status.
  
  
  METHODS
  Recruitment strategies included safeguarding confidentiality, involving ocal health-care professionals, advertising, and participation incentives. Urine toxicology, CD4 cell count, HIV viral load, blood chemistry, plasma micronutrients, dietary history, drug use and morbidity were assessed for two years.
  
  
  RESULTS
  Targeted outreach identified 138 HIV-infected persons who used marijuana; 18.1% had CD4 cell counts ≤ 350 cells/μL and 39.9% had low BMI. Eligible marijuana users (N=52) had significantly lower BMI (21.8 3.7 vs. 24.3 ± 5.3 kg/m2,P=0.001), higher HIV viral load (4.36 ± 0.89 vs. 4.09 ± 0.89 log10,P=0.018), and higher kilocalorie intake (1924 ± 1055 vs. 1620 ± 926 Kcalories,P=0.025) than those who did not use marijuana (N=748) with similar CD4 cell count. Marijuana users ≥ 40 years old had more opportunistic diseases (P=0.020) than non-users of the same age. Benzodiazepine use was detected among 57 participants and they had higher BMI than marijuana users (24.4 ± 6.8 vs. 21.8 ± 3.7 kg/m2,P= 0.017).
  
  
  CONCLUSIONS
  A population stigmatized by illicit drug use and HIV-infection can be brought into a clinical research setting in Africa. HIV-infected marijuana users were at a risk for higher HIV viral load, lower BMI and more comorbidities than nonusers. Outreach to this marginalized group is important for containing the HIV epidemic.
authors: Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, USA.
authors: Marianna K
authors: MK
authors: Baum
authors: Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, USA.
authors: Adriana
authors: A
authors: Campa
authors: University of Miami, School of Medicine, Miami, Florida, USA.
authors: J Bryan
authors: JB
authors: Page
authors: Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
authors: Shenghan
authors: S
authors: Lai
authors: Botswana Harvard Partnership, Gaborone, Botswana.
authors: Lesedi
authors: L
authors: Tsalaile
authors: Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, USA.
authors: Sabrina Sales
authors: SS
authors: Martinez
authors: Harvard School of Public Health, Boston, Massachusetts, USA.
authors: Patricia
authors: P
authors: Burns
authors: Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, USA.
authors: O'Dale
authors: O
authors: Williams
authors: Florida International University, Robert Stempel College of Public Health and Social Work, Miami, Florida, USA.
authors: Yinghui
authors: Y
authors: Li
authors: Botswana Harvard Partnership, Gaborone, Botswana.
authors: Erik
authors: E
authors: van Widenfelt
authors: Botswana Harvard Partnership, Gaborone, Botswana.
authors: Herman
authors: H
authors: Bussmann
authors: Botswana Harvard Partnership, Gaborone, Botswana.
authors: Moyo
authors: M
authors: Sikhulele
authors: Botswana Harvard Partnership, Gaborone, Botswana.
authors: Joseph
authors: J
authors: Makhema
authors: Harvard School of Public Health, Boston, Massachusetts, USA.
authors: Myron
authors: M
authors: Essex
authors: Harvard School of Public Health, Boston, Massachusetts, USA.
authors: Richard
authors: R
authors: Marlink
keywords: Benzodiazepines; Botswana; HIV; HIV disease progression; Marijuana; Nutritional status; Recruitment