title: Longer duration of homelessness is associated with a lower likelihood of non-detectable plasma HIV-1 RNA viral load among people who use illicit drugs in a Canadian setting.
abstract: Homelessness is common among people who use drugs (PWUD) and, for those living with HIV/AIDS, an important contributor to sub-optimal HIV treatment outcomes. This study aims to investigate the relationship between the duration of homelessness and the likelihood of plasma HIV-1 RNA viral load (VL) non-detectability among a cohort of HIV-positive PWUD. We used data from the ACCESS study, a long-running prospective cohort study of HIV-positive PWUD linked to comprehensive HIV clinical records including systematic plasma HIV-1 RNA VL monitoring. We estimated the longitudinal relationship between the duration of homelessness and the likelihood of exhibiting a non-detectable VL (i.e., <500 copies/mL plasma) using generalized linear mixed-effects modelling. Between May 1996 and June 2014, 922 highly active antiretroviral therapy-exposed participants were recruited and contributed 8188 observations. Of these, 4800 (59%) were characterized by non-detectable VL. Participants reported they were homeless in 910 (11%) interviews (median: six months, interquartile range: 6-12 months). A longer duration of homelessness was associated with lower odds of VL non-detectability (adjusted odds ratio = 0.71 per six-month period of homelessness, 95% confidence interval: 0.60-0.83) after adjustment for age, ancestry, drug use patterns, engagement in addiction treatment, and other potential confounders. Longer durations of episodes of homelessness in this cohort of HIV-positive illicit drug users were associated with a lower likelihood of plasma VL non-detectability. Our findings suggest that interventions that seek to promptly house homeless individuals, such as Housing First approaches, might assist in maximizing the clinical and public health benefits of antiretroviral therapy among people living with HIV/AIDS.
authors.affiliation: a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: Loh
authors.affiliation: a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.
authors.forename: Mary Clare
authors.initials: MC
authors.lastname: Kennedy
authors.affiliation: a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.|b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.|b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.
authors.forename: Brandon
authors.initials: B
authors.lastname: Marshall
authors.affiliation: a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.
authors.forename: Surita
authors.initials: S
authors.lastname: Parashar
authors.affiliation: a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.|b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada.
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.affiliation: a British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital , Vancouver , Canada.|b Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002170:Canada; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D015497:HIV-1 / Q000302:isolation & purification*; D006703:Ill-Housed Persons; D006801:Humans; D013287:Illicit Drugs; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D019966:Substance-Related Disorders / Q000150:complications*; D013997:Time Factors; D019562:Viral Load
chemical_list: D013287:Illicit Drugs; D012367:RNA, Viral
keywords: Adherence; homelessness; injection drug use; viral load; viral suppression