Faster entry into HIV care among HIV-infected drug users who had been in drug-use treatment programs.
We evaluated whether being in drug use treatment improves linkage to HIV medical care for HIV-infected drug users. We assessed whether an evidence-based intervention for linkage to care ['ARTAS'] works better for HIV-infected drug users who had been in drug use treatment than those who had not.



Randomized trial.



295 Participants in the Antiretroviral Treatment Access Study ['ARTAS'] trial were followed for time to first HIV medical care. Drug use (injected and non-injected drugs) in the last 30days and being in drug treatment in the last 12 months were assessed by audio-CASI. We used a proportional hazards model of time to care in drug users with and without drug treatment, adjusting for barriers to care, AIDS symptoms, and demographic factors. We tested whether drug treatment modified the intervention effect by using a drug use/drug treatment*intervention interaction term.



Ninety-nine participants (30%) reported drug use in the 30days before enrollment. Fifty-three (18%) reported being in a drug treatment program in the last 12 months. Drug users reporting methadone maintenance became engaged in care in less than half the time of drug users without a treatment history [HR 2.97 (1.20, 6.21)]. The ARTAS intervention effect was significantly larger for drug users with a treatment history compared to drug users without a treatment history (AHR 5.40, [95% CI, 2.03-14.38]).



Having been in drug treatment programs facilitated earlier entry into care among drug users diagnosed with HIV infection, and improved their response to the ARTAS linkage intervention.
Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA. Electronic address: lig0@cdc.gov.
Lytt I
LI
Gardner
Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA. Electronic address: gdm8@cdc.gov.
Gary
G
Marks
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: sstrathdee@ucsd.edu.
Steffanie A
SA
Strathdee
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: anita.loughlin@optum.com.
Anita M
AM
Loughlin
Department of Global Health, Rollins School of Public Health, and Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: cdelrio@emory.edu.
Carlos
C
Del Rio
Department of Internal Medicine, Division of Infectious Disease, Los Angeles County and University of Southern California Medical Center, Los Angeles, CA, USA. Electronic address: prk1@cdc.gov.
Peter
P
Kerndt
Health Research Association, Los Angeles, CA, USA. Electronic address: pam.mahoney@epiresources.com.
Pamela
P
Mahoney
Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA. Electronic address: vval@cdc.gov.
Marc A
MA
Pitasi
University of Miami School of Medicine, Miami, FL, USA. Electronic address: lm2892@cumc.columbia.edu.
Lisa R
LR
Metsch
D000293:Adolescent; D000328:Adult; D003710:Demography; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D058850:Opiate Substitution Treatment; D016016:Proportional Hazards Models; D019966:Substance-Related Disorders / Q000150:complications / Q000188:drug therapy*; D013997:Time Factors; D055815:Young Adult
D008691:Methadone
HIV; Linkage to HIV medical care; Randomized trial; Substance use