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Barriers to HIV care and antiretroviral treatment (ART) among HIV-infected crack users in the United States
Presented by Christine Bell, United States.
C. Bell1, G. Cardenas2, T. Sullivan1, T. Kuper2, L. Gooden2, J. Kaplan1, E. Scharf1, A. Rodriguez2, C. del Rio1, L. Metsch2
1Emory University School of Medicine and Emory CFAR, Department of Medicine, Division of Infectious Diseases, Atlanta, United States, 2University of Miami School of Medicine and U. Miami D-CFAR, Department of Epidemiology, Miami, United States
Background: Studies have associated HIV crack users with non-adherence to care (Melchior et al., 2001; Cohen et al., 2004). We studied barriers to HIV care and treatment among HIV infected crack users hospitalized in the US.
Methods: Structured interviews were conducted with HIV-infected crack users in two inner city hospitals in the US (Jackson Hospital in Miami, FL and Grady Hospital in Atlanta, GA) between August 2006 - January 2008. Chi square analyses were used to determine significant associations among the data.
Results: One hundred and ninety HIV-infected crack using patients were interviewed during a hospitalization; 53% were women, most were Black (89%) and over the age of 40 (71%). Seventeen percent of participants reported never having seen an HIV provider, 50% reported not having been seen by an HIV provider in the past 6 months, and 76% were not receiving ART. Women were less likely to report being helped into HIV care (58% vs. 70%; p<0.033) and to have ever seen an HIV provider (78% vs. 89%; p<0.033). Participants who reported an annual income of < $5000 were also less likely to have seen an HIV provider (78% vs. 94%; p<0.006). Participants who reported having been helped into HIV care upon diagnosis were more likely to have seen an HIV provider (92% vs. 67%; p<0.001). There were no significant differences for likelihood of being on ART by gender, income, or time since diagnosis. Participants with stable housing (28% vs. 14%; p<0.010) and those who had been referred to a case manager upon diagnosis (31% vs. 18%; p<0.020) were more likely to be on ART.
Conclusions: These findings suggest that to link HIV-positive crack users, and particularly women, into care and ART, a multifaceted intervention that includes care management, substance abuse treatment and strategies to improve socioeconomic stability is needed.
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