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Decreasing initiation of HAART and treatment delay among injection drug users, 19962006, Baltimore,

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Decreasing initiation of HAART and treatment delay among injection drug users, ... DD Celentano1, J Astemborski1, SH Mehta1, GD Kirk1,2 ... – PowerPoint PPT presentation

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Title: Decreasing initiation of HAART and treatment delay among injection drug users, 19962006, Baltimore,


1
Decreasing initiation of HAART and treatment
delay among injection drug users, 1996-2006,
Baltimore, MD USA
  • DD Celentano1, J Astemborski1, SH Mehta1, GD
    Kirk1,2
  • 1 Johns Hopkins Bloomberg School of Public Health
  • 2 Johns Hopkins School of Medicine

2
Background
  • Injection drug users (IDUs) have lagged behind
    other groups with respect to initiating highly
    active antiretroviral therapy (HAART)
  • We previously demonstrated that HAART initiation
    was slowly increasing among a cohort of IDUs in
    Baltimore, MD, USA between 1996 and 1999
    (Celentano et al, JAMA 2000)
  • Inconsistent health care access utilization,
    use of suboptimal (non-HAART) regimens and
    continuing drug use were identified as barriers
    to HAART initiation

3
Objective
  • As treatments have been simplified and concerns
    related to adherence diminished, IDUs would be
    expected to more readily initiate HAART
  • We characterized temporal trends and predictors
    of HAART initiation among treatment eligible IDUs
    from January 1996 through December 2006

4
Methods
  • Study population
  • AIDS Linked to the IntraVenous Experience (ALIVE)
  • 2946 IDUs enrolled in 1988 (24 HIV positive)
  • Additional recruitments in 1994-95, 1998
  • A total of 1206 HIV positive recruited
  • Study sample
  • 737 HIV positive in follow-up in January 1996
  • 629 HAART eligible (CD4lt350 cells/?l) IDUs with gt
    2 follow-up visits

5
Statistical Analysis
  • Date of HAART initiation defined as midpoint of
    last visit where HAART was not reported and first
    visit where HAART was reported
  • HAART was considered to be a regimen of 3 drugs
    consisting of at least a PI, NNRTI or Abacavir
  • Annual rates of HAART initiation per 100
    person-years of observation were calculated to
    characterize temporal trends
  • Poisson regression was used to identify
    predictors of HAART initiation

6
Results Characteristics at HAART eligibility
  • Median age, 41 years (IQR 36-45)
  • 97 African American
  • 25 Female
  • 71 prior AIDS diagnosis
  • 87 were ART experienced
  • Median CD4 at eligibility, 230 (IQR 134, 294)
  • Median follow-up 4.3 years (IQR 1.6,7.8)

7
Results Outcomes
8
Temporal trends in HAART initiation, 1996-2006
9
Temporal trends in initial HAART regimen,
1996-2006
10
Temporal trends in treatment delay, 1996-2006
Plt0.001 for both (test for trend)
11
Adjusted predictors of HAART initiation, 1996-2006
12
Conclusions
  • In Baltimore IDUs, overall rates of HAART
    initiation have remained relatively stable but
    are not improving.
  • Delays between eligibility and HAART initiation
    are increasing
  • This is consistent with data from the Johns
    Hopkins HIV clinic (Baltimore, USA) which
    suggests that patients are presenting for care at
    later stages and lower CD4 cell counts
    (Keruly J et al, 2008)

13
Conclusions
  • Identified barriers to HAART included daily
    injection and use of other drugs
  • Facilitators of HAART initiation were medical
    care access and continuity
  • A significant number of eligible persons appear
    intransigent to initiation of therapy despite
    counseling, examination, routine testing and
    active referral

14
Acknowledgements
  • ALIVE co-investigators
  • ALIVE study staff participants
  • National Institute on Drug Abuse
  • (DA04334, DA12568)
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