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Open Access 01-06-2011

Homelessness and Adherence to Antiretroviral Therapy among a Cohort of HIV-Infected Injection Drug Users

Authors: Anita Palepu, M-J Milloy, Thomas Kerr, Ruth Zhang, Evan Wood

Published in: Journal of Urban Health | Issue 3/2011

Abstract

Homelessness is prevalent among HIV-infected injection drug users (IDU) and may adversely affect access and adherence to antiretroviral therapy (ART). There are limited descriptions of the effect of homelessness on adherence to ART in long-term cohorts of HIV-infected IDU. We used data from a community-recruited prospective cohort of HIV-infected IDU, including comprehensive ART dispensation records, in a setting where HIV care is free. We examined the relationship between the homelessness measured longitudinally, and the odds of ≥95% adherence to ART using generalized estimating equations logistic regression modeling adjusting for sociodemographics, drug use, and clinical variables. Between May 1996 and September 2008, 545 HIV-infected IDU were recruited and eligible for the present study. The median follow-up duration was 23.8 months (IQR 8.5–91.6 months) contributing 2,197 person-years of follow-up. At baseline, homeless participants were slightly younger (35.8 vs. 37.9 years, p = 0.01) and more likely to inject heroin at least daily (37.1% vs. 24.6%. p = 0.004) than participants who had housing. The multivariate model revealed that homelessness (adjusted odds ratio [AOR] 0.66; 95% CI: 0.53–0.84) and frequent heroin use (AOR 0.40; 95% CI: 0.30–0.53) were significantly and negatively associated with ART adherence, whereas methadone maintenance was positively associated (AOR 2.33; 95% CI: 1.86–2.92). Sub-optimal ART adherence was associated with homelessness and daily injection heroin use among HIV-infected IDU. Given the survival benefit of ART, it is critical to develop and evaluate innovative strategies such as supportive housing and methadone maintenance to address these risk factors to improve adherence.

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Title: Homelessness and Adherence to Antiretroviral Therapy among a Cohort of HIV-Infected Injection Drug Users
Authors: Anita Palepu
M-J Milloy
Thomas Kerr
Ruth Zhang
Evan Wood
Publication date: 01-06-2011
Publisher: Springer US
Published in: Journal of Urban Health / Issue 3/2011
Print ISSN: 1099-3460
Electronic ISSN: 1468-2869
DOI: https://doi.org/10.1007/s11524-011-9562-9

At a glance: The STEP trials

Springer Medicine

Homelessness and Adherence to Antiretroviral Therapy among a Cohort of HIV-Infected Injection Drug Users

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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