title: The impact of an HIV/AIDS adult integrated health program on leaving hospital against medical advice among HIV-positive people who use illicit drugs.
abstract: Leaving hospital against medical advice (AMA) is a major source of avoidable morbidity, mortality and healthcare expenditure. The objective of this study was to assess the impact of an innovative HIV/AIDS adult integrated health program on leaving hospital AMA among HIV-positive people who use illicit drugs (PWUD).
  
  
  
  Using generalized estimating equations, we examined the relationship between being a participant of the Dr. Peter Centre (DPC), a specialty HIV/AIDS-focused adult integrated health program, and leaving hospital AMA among a cohort of HIV-positive PWUD patients.
  
  
  
  Between July 2005 and July 2011, 181 HIV-positive PWUD who experienced ≥1 hospitalization were recruited into the study. Of the 406 hospital admissions among these individuals, 73 (39.9%) participants left the hospital AMA. In a multivariable model adjusted for confounders, being a participant of the DPC was independently associated with lower odds of leaving hospital AMA (adjusted odds ratio = 0.42; 95% confidence interval: 0.19-0.89).
  
  
  
  Our findings suggest that the provision of a broad range of clinical, harm reduction and support services through an innovative HIV/AIDS-focused adult integrated health program operating in proximity to a hospital may curb the rate at which individuals leave hospital prematurely.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.|Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9.
authors.forename: Lianping
authors.initials: L
authors.lastname: Ti
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.|Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.affiliation: Dr. Peter AIDS Foundation, 1110 Comox Street, Vancouver, BC, CanadaV6E 1K5.
authors.forename: Rosalind Baltzer
authors.initials: RB
authors.lastname: Turje
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.|Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9.
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.|Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.|Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000523:psychology*; D000328:Adult; D015331:Cohort Studies; D055030:Drug Users / Q000193:education* / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D019966:Substance-Related Disorders / Q000523:psychology*
keywords: HIV; discharge against medical advice; hospital; people who use illicit drugs