Dose-response Effect of Incarceration Events on Nonadherence to HIV Antiretroviral Therapy Among Injection Drug Users


Milloy, MJ; Kerr, T; Buxton, J; Rhodes, T; Guillemi, S; Hogg, R; Montaner, J; Wood, E; (2011) Dose-response Effect of Incarceration Events on Nonadherence to HIV Antiretroviral Therapy Among Injection Drug Users. The Journal of infectious diseases, 203 (9). pp. 1215-1221. ISSN 0022-1899 DOI: https://doi.org/10.1093/infdis/jir032

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Abstract

Background. Although some studies have identified impressive clinical gains for incarcerated HIV-seropositive injection drug users (IDUs) undergoing antiretroviral therapy (ART), the effect of incarceration on adherence to ART remains undetermined. Methods. We used data from a long-term community-recruited cohort of HIV-seropositive IDUs, including comprehensive ART dispensation records, in a setting where HIV care is free. We estimated the relationship between the cumulative burden of incarceration, measured longitudinally, and the odds of < 95% adherence to ART, with use of multivariate modeling. Results. From 1996 through 2008, 490 IDUs were recruited and contributed 2220 person-years of follow-up; 271 participants (55.3%) experienced an incarceration episode, with the number of incarcerations totaling 1156. In a multivariate model, incarceration had a strong dose-dependent effect on the likelihood of nonadherence to ART: 1-2 incarceration events (adjusted odds ratio [AOR], 1.49; 95% confidence interval [95% CI], 1.03-2.05), 3-5 events (AOR, 2.48; 95% CI, 1.62-3.65), and > 5 events (AOR, 3.11; 95% CI, 1.86-4.95). Conclusions. Among HIV-seropositive IDUs receiving ART, an increasing burden of incarceration was associated with poorer adherence in a dose-dependent fashion. Our findings support improved adherence support for HIV-seropositive IDUs experiencing incarceration.

Item Type: Article
Keywords: INFECTED PRISONERS, MEDICATION ADHERENCE, SUBSTANCE-ABUSE, CELL COUNT, VANCOUVER, SURVIVAL, OUTCOMES, RELEASE, IMPACT, DETERMINANTS
Faculty and Department: Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
PubMed ID: 21459814
Web of Science ID: 289306100003
URI: http://researchonline.lshtm.ac.uk/id/eprint/840

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