Barriers to HIV care and Antiretroviral Treatment ART among HIVinfected Crack Users in the United St

1
Barriers to HIV care and Antiretroviral Treatment
(ART) among HIV-infected Crack Users in the
United States

• Christine Bell 1 Gabriel Cardenas 2 Tanisha
  Sullivan 1 Tamy Kuper 2 Lauren Gooden 2 Jessica
  Kaplan 1 Elizabeth Scharf 1 Allan Rodriguez 2
  Carlos del Rio 1 Lisa Metsch 2
• 1 Emory University School of Medicine,
  Department of Medicine, Division of Infectious
  Diseases, and Emory CFAR and the Department of
  Epidemiology
• 2 University of Miami Miller School of Medicine,
  Department of Epidemiology and Public Health and
  Medicine and U. Miami D-CFAR.

2
Background

• About 1 in 4 persons living with HIV are not
  regularly attending HIV primary care
• HIV-infected drug users are less likely to
  utilize HIV primary care and receive HAART
• HIV-infected drug users also have higher rates of
  hospitalization and are more likely to leave the
  hospital against medical advice
• Use of crack cocaine continues to flourish in
  many inner-cities in the U.S.

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Study objectives

• To describe barriers to HIV care and
  antiretroviral treatment among HIV infected crack
  users hospitalized in Grady Memorial Hospital
  (Atlanta) and Jackson Memorial Hospital (Miami).
• To assess factors associated with ever having had
  an HIV primary care provider
• To assess association with ever having received
  Antiretroviral Treatment (ART)

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Methods

• Structured interviews were conducted with
  HIV-infected crack users who were admitted to two
  inner city hospitals in the US between August
  2006 January 2008.
• Interview eligibility criteria
• Hospitalized HIV patient at GMH or JMH were
  screened prior to interview to establish
• 1) Sexual intercourse in the past 6 months
• 2) Crack-cocaine use in the past year
• Data Analysis
• Logistic regression analyses were used to
  identify significant associations among the
  variables.
• IRB approval was obtained from Emory IRB and
  Miami IRB
• and full informed consent was obtained from
  study participants before interview.

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Demographic characteristics of study participants

• Atlanta Grady Hospital
• 141 study participants
• 55 female, 45 male
• 92 Black, 8 Other
• Average age 44 years old
• Miami Jackson Hospital
• 80 study participants
• 48 female, 52 male
• 86 Black, 14 Other
• Average age 43 years old
• Overall
• lt 5000 annual income 70
• gt 5 yrs since HIV diagnosis 69
• Homeless 49

Grady Memorial Hospital
Jackson Memorial Hospital
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History of HIV care and treatment
No
Yes
No
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Variables forced into model After adjusting
for site, gender, age, and ethnicity
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• Variables not found to have a significant
• association with going to HIV care in our data
• Education level Attitude toward HIV care
• Provider responsiveness Level of
  crack/alcohol
  
  consumption
• Putting off HIV care due to drugs/alcohol
  Housing stability
• Unprotected sex in previous 6 months Level of
  depression
• Referral to a case manager Having children
• Social support
• History of incarceration
• Level of HIV knowledge
• Variables not selected by backward stepwise at
  the 0.05 significance level to be associated in
  multivariate form with the dependent variable.

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Variables forced into model After adjusting
for site, gender, age, and ethnicity
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• Variables not found to have a significant
• association with taking HIV medications in our
  data
• Education level Having children
• Income Self-efficacy for taking
  HIV meds
• Putting off HIV care because of Attitude for
  taking HIV meds
• drugs/alcohol Level
  of depression
• Unprotected sex in previous 6 months
• Referral to a case manager upon diagnosis
• Social support
• Empowerment
• Level of crack/alcohol consumption
• Housing stability
• Variables not selected by backward stepwise at
  the 0.05 significance level to be associated in
  multivariate form with the dependent variable.

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Study Limitations

• Self report
• HIV, sexual, drug and social histories provided
  by study participants were assumed to be accurate
• Interview bias
• It is possible that participants provided
  answers that were most pleasing or acceptable to
  interviewer
• Other factors related to use of care and
  treatment
• There may be other factors related to
  utilization of HIV care and treatment among HIV
  crack users not covered in structured interviews.
  Interview data has not yet been corroborated
  with medical chart abstraction.

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Implications for HIV public health policy

• In order to bring HIV infected crack users into
  primary HIV care, to keep them in care and to
  allow them to benefit from prevention and
  treatment interventions
• Policy development
• A multifaceted intervention is needed that
  includes
• HIV care management
• Substance abuse treatment and,
• Strategies to improve socioeconomic stability
• Project HOPE Hospital Visit is an Opportunity
  for Prevention and Engagement with HIV-positive
  Crack Users

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Acknowledgements

• Atlanta Site Funding
• Carlos del Rio, MD, Co-PI NIH/NIDA (RO1
  DA017612)
• Richard Rothenberg, M.D., Investigator
  NIH/NIAID (P30 AI050409)
• Tanisha Sullivan, Project Director
  Emory Center for AIDS Research (CFAR)
• Jessica Kaplan, Interviewer
  NIH/NIAID (1P30 AI023961)
• Elizabeth Scharf, Interviewer
  University of Miami Developmental
• Mary Yohannan, Facilitator
  Center for AIDS Research (DCFAR)
• Ossie Williams, Outreach Worker
• Miami Site
• Lisa Metsch PhD, PI
• Allan Rodriguez, MD, Co-PI
• Toye Brewer, MD, Co-I
• Margaret Pereyra, PhD, Co-I
• Shari Messinger, PhD, Biostat
• Lauren Gooden, MPH, Project Director
• Gabriel Cardenas, MPH, Data Manager
• Tamy Kuper, BA Project Director/ Interviewer
• Ginny Locascio, LPN, Facilitator