The effect of engagement in an HIV/AIDS integrated health programme on plasma HIV-1 RNA suppression among HIV-positive people who use illicit drugs: a marginal structural modelling analysis.
HIV treatment-as-prevention campaigns emphasize early diagnosis and immediate access to care and antiretroviral therapy for HIV-positive individuals in order to increase levels of plasma HIV RNA viral load (VL) suppression. However, the possible role of harm reduction-based programmes in this objective has not yet been well evaluated. The objective of the study was to examine the relationship between being a client of the Dr. Peter Centre (DPC; an HIV/AIDS-focused adult integrated health programme) and VL suppression among highly active antiretroviral therapy (HAART)-exposed HIV-positive people who use illicit drugs (PWUD) in Vancouver, Canada.



Data were derived from the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) study, a study of a community-recruited cohort of HIV-positive PWUD. A marginal structural model using inverse probability of treatment weights was used to estimate the longitudinal relationship between being a DPC client and exhibiting a VL < 50 HIV-1 RNA copies/mL plasma.



Between 2005 and 2014, 746 HAART-exposed participants were included in the study, of whom 269 (36.1%) reported being a DPC client at some time during the study period. A marginal structural model estimated a 1.54 greater odds of achieving VL suppression (95% confidence interval 1.20-1.99) among DPC clients.



Our findings demonstrate that participating in an innovative HIV/AIDS-focused adult integrated health programme that provides a broad range of clinical, harm reduction, and support services may contribute to optimizing the benefits of HAART in terms of morbidity, mortality and viral transmission among PWUD, and as a result help to fulfill the goals of the treatment-as-prevention strategy.
St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
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Dong
St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Kerr
Dr. Peter AIDS Foundation, Vancouver, BC, Canada.
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Turje
St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
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Parashar
St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
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Min
St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Montaner
St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Wood
St. Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.|Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Milloy
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002170:Canada; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000821:virology; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D019966:Substance-Related Disorders / Q000150:complications*; D019562:Viral Load
D044966:Anti-Retroviral Agents; D012367:RNA, Viral
Canada; HIV/AIDS; harm reduction; people who use illicit drugs; viral load suppression