title: Antiretroviral Therapy Interruption Among HIV Postive People Who Use Drugs in a Setting with a Community-Wide HIV Treatment-as-Prevention Initiative.
abstract: HIV Treatment as Prevention (TasP) initiatives promote antiretroviral therapy (ART) access and optimal adherence (≥95 %) to produce viral suppression among people living with HIV (PLHIV) and prevent the onward transmission of HIV. ART treatment interruptions are common among PLHIV who use drugs and undermine the effectiveness of TasP. Semi-structured interviews were conducted with 39 PLHIV who use drugs who had experienced treatment ART interruptions in a setting with a community-wide TasP initiative (Vancouver, Canada) to examine influences on these outcomes. While study participants attributed ART interruptions to "treatment fatigue," our analysis revealed individual, social, and structural influences on these events, including: (1) prior adverse ART-related experiences among those with long-term treatment histories; (2) experiences of social isolation; and, (3) breakdowns in the continuity of HIV care following disruptive events (e.g., eviction, incarceration). Findings reconceptualise 'treatment fatigue' by focusing attention on its underlying mechanisms, while demonstrating the need for comprehensive structural reforms and targeted interventions to optimize TasP among drug-using PLHIV.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada. rmcneil@cfenet.ubc.ca.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada. rmcneil@cfenet.ubc.ca.
authors.forename: Ryan
authors.identifier: http://orcid.org/0000-0001-9555-7693
authors.initials: R
authors.lastname: McNeil
authors.affiliation: BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.affiliation: BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada.
authors.forename: Bill
authors.initials: B
authors.lastname: Coleman
authors.affiliation: Kirby Institute of Infection and Immunity, UNSW Australia, Sydney, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Maher
authors.affiliation: BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: M J
authors.initials: MJ
authors.lastname: Milloy
authors.affiliation: BC Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, BC, V6T 1Z1, Canada.|Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
authors.forename: Will
authors.initials: W
authors.lastname: Small
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001955:British Columbia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D036301:Qualitative Research; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; Drug users; HIV Treatment as Prevention; HIV/AIDS; Qualitative research; Treatment discontinuation