Faster entry into HIV care among HIV-infected drug users who had been in drug-use treatment programs. (1st August 2016) - Gardner, Lytt I.
Highlights: Do drug use treatment programs lead to faster entry to care among drug users? Defined drug use (ever/recent) with and without history of drug treatment (5 levels). Used a proportional hazards model-time to HIV care entry for drug use/drug treatment. Methadone maintenance treatment had shortest time to care. Antiretroviral Treatment Access Study (ARTAS) care entry intervention effect larger for users with a drug treatment history. Abstract: Objective: 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. Design: Randomized trial. Methods: 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 30 days 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. Results: Ninety-nine participants (30%) reported drug use in the 30 days 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]). Conclusions: 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.