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Communitywide HIV interventions improve care among illicit drug users
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A communitywide intervention program targeting illicit drug users with HIV appeared to have several long-term benefits, including increased viral suppression and reduced HIV drug resistance, according to a recently published study.
“Given high levels of preventable HIV/AIDS-related morbidity and mortality observed among [people who use illicit drugs (PWUD)] worldwide, our results support redoubling efforts to scale-up ART among HIV-seropositive PWUD,” Thomas Kerr, PhD, co-director of the Urban Health Research Initiative at the British Columbia Centre for Excellence in HIV/AIDS, and colleagues wrote in Clinical Infectious Diseases.
Thomas Kerr
The researchers examined a cohort of adult Canadian drug users with HIV enrolled in the ACCESS study from January 2006 to June 30, 2014. ACCESS introduced patients to care using community-based outreach methods, and included efforts to increase testing and ART initiation. Participants completed a survey and underwent examination in 6-month intervals, with those completing one or more viral load tests included in the present analysis. Researchers observed changes in viral load among individual participants and the proportion of the cohort achieving undetectable viral loads (< 50 copies/mL) over the course of the study. ART resistance also was observed, with samples determined to be resistant if they contained one or more resistance mutations to antiretroviral agents.
The mean age among the 819 recruited participants was 40.9 years; 33.7% were women. Analyses included 25,746 viral load tests and 6,095 person-years of observation. Along with a decline in average viral load, the proportion of participants with undetectable loads increased from 28.1% to 62.9% (P < .001). Other outcomes included a decrease in participants with no exposure to ART (P < .001), an increase in those with 95% or better adherence (P < .001) and a decline in the incidence of HIV drug resistance (P = .011).
“These results have immediate relevance to settings with sub-optimal coverage of ART among HIV-positive PWUD,” Kerr and colleagues wrote. “Although Treatment-as-Prevention is increasingly recognized as a cornerstone of the global effort to control the HIV/AIDS pandemic and has been adopted in several jurisdictions with substantial epidemics among PWUD, there is very limited data on efforts to scale-up ART among members of these groups. A key concern remains the criminalization of PWUD, which has fostered persistent barriers to optimal
HIV treatment outcomes in many settings.” – by Dave Muoio
Disclosures: Milloy and Kerr report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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