Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Perceived access and barriers to care among illicit drug users and hazardous drinkers: findings from the Seek, Test, Treat, and Retain data harmonization initiative (STTR)

Authors: Mika Matsuzaki, Quan M. Vu, Marya Gwadz, Joseph A. C. Delaney, Irene Kuo, Maria Esther Perez Trejo, William E. Cunningham, Chinazo O. Cunningham, Katerina Christopoulos

Published in: BMC Public Health | Issue 1/2018

Login to get access

Abstract

Background

Illicit drug use (DU) and hazardous drinking (HD) among marginalized populations may be associated with greater barriers to care.

Methods

We used baseline data on the participants of the Seek, Test, Treat, and Retain data harmonization initiative. DU includes use of any illicit drugs within the past 6 months. HD was defined as scores ≥8 for men and ≥ 7 for women on Alcohol Use Disorders Identification Test within the past 12 months. Social support scores were assigned by summing scores from individual questions related to social support. Two outcomes for multivariable regression models and mediation analysis were perceived access to care and perceived barriers to care scores, calculated from summated points from individual questions within each domain. All models were adjusted for age, gender, race/ethnicity, and social support and stratified by HIV status.

Results

Among 1403 illicit drug users and 4984 non-drug users, the mean age was 39.6 ± 12.2 years old, 71% were male, 57% African Americans, and 39% Hispanic/Latinos. Over 25% reported difficulties in covering medical costs and finding transportation to health care facilities and greater proportions of drug users and hazardous drinkers reported these issues than non-DU/non-HD. In multivariable models, DU and HD were both independently associated with having greater barriers to care (β: 0.49 (95% confidence interval: 0.19 to 0.79) p < 0.01; 0.31 (0.18 to 0.45) < 0.01) in HIV-negative participants. Neither DU nor HD was strongly associated with barriers to care for HIV-positive participants. Social support was associated with better perceived access to care and fewer barriers to care in the HIV-negative participants.

Conclusion

The current study found that financial burdens of care, logistical difficulties in accessing care, and low social support were common challenges among individuals using illicit drugs and/or drinking hazardously. Addressing structural barriers and strengthening social support may be important strategies to improve health care among marginalized populations, regardless of HIV status.
Appendix
Available only for authorised users
Literature
1.
2.
Cunningham WE, Andersen RM, Katz MH, Stein MD, Turner BJ, Crystal S, et al. The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States. Med Care. 1999;37:1270–81.CrossRefPubMed
3.
Cunningham WE, Hays RD, Williams KW, Beck KC, Dixon WJ, Shapiro MF. Access to medical care and health-related quality of life for low-income persons with symptomatic human immunodeficiency virus. Med Care. 1995;33:739–54.CrossRefPubMed
4.
Ngo-Metzger Q, Massagli MP, Clarridge BR, Manocchia M, Davis RB, Iezzoni LI, et al. Linguistic and Cultural Barriers to Care. J Gen Intern Med. 2003;18:44–52.CrossRefPubMedPubMedCentral
5.
DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol Off J Div Health Psychol Am Psychol Assoc. 2004;23:207–18.
6.
7.
Halbert CH, Armstrong K, Gandy OH, Shaker L. Racial differences in trust in health care providers. Arch Intern Med. 2006;166:896–901.CrossRefPubMed
8.
Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, et al. The Role of Stigma and Medical Mistrust in the Routine Health Care Engagement of Black Men Who Have Sex With Men. Am J Public Health. 2014;105:e75–82.CrossRef
9.
10.
11.
12.
Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Report No.: H4HS Publication No. (SMA); 2014. p. 14–4863.
13.
14.
Garfein RS, Vlahov D, Galai N, Doherty MC, Nelson KE. Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses. Am J Public Health. 1996;86:655–61.CrossRefPubMedPubMedCentral
15.
16.
17.
18.
Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care STDs. 2007;21:584–92.CrossRefPubMed
19.
20.
21.
22.
Chandler RK, Kahana SY, Fletcher B, Jones D, Finger MS, Aklin WM, et al. Data Collection and Harmonization in HIV Research: The Seek, Test, Treat, and Retain Initiative at the National Institute on Drug Abuse. Am J Public Health. 2015;105:2416–22.CrossRefPubMedPubMedCentral
23.
Christopoulos KA, Riley ED, Tulsky J, Carrico AW, Moskowitz JT, Wilson L, et al. A text messaging intervention to improve retention in care and virologic suppression in a U.S. urban safety-net HIV clinic: study protocol for the Connect4Care (C4C) randomized controlled trial. BMC Infect. Dis. 2014;14:718.
24.
25.
Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addict Abingdon Engl. 1993;88:791–804.CrossRef
26.
Hays RD, Cunningham WE, Ettl MK, Beck CK, Shapiro MF. Health Related Quality of Life in HIV Disease. Assessment. 1995;2:363–80.CrossRef
27.
Fleishman JA, Sherbourne CD, Crystal S, Collins RL, Marshall GN, Kelly M, et al. Coping, conflictual social interactions, social support, and mood among HIV-infected persons. HCSUS Consortium. Am J Community Psychol. 2000;28:421–53.CrossRefPubMed
28.
Kalichman SC, Catz S, Ramachandran B. Barriers to HIV/AIDS treatment and treatment adherence among African-American adults with disadvantaged education. J Natl Med Assoc. 1999;91:439–46.PubMedPubMedCentral
29.
Kreyszig E. Advanced Engineering Mathematics. 4th ed. New York: John Wiley & Sons Inc; 1979.
30.
31.
32.
33.
34.
Edlin BR, Kresina TF, Raymond DB, Carden MR, Gourevitch MN, Rich JD, et al. Overcoming Barriers to Prevention, Care, and Treatment of Hepatitis C in Illicit Drug Users. Clin Infect Dis. 2005;40:S276–85.CrossRefPubMedPubMedCentral
35.
Golub ET, Latka M, Hagan H, Havens JR, Hudson SM, Kapadia F, et al. Screening for depressive symptoms among HCV-infected injection drug users: examination of the utility of the CES-D and the Beck Depression Inventory. J Urban Health Bull N Y Acad Med. 2004;81:278–90.CrossRef
36.
Oleski J, Mota N, Cox BJ, Sareen J. Perceived Need for Care, Help Seeking, and Perceived Barriers to Care for Alcohol Use Disorders in a National Sample. Psychiatr Serv. 2010;61:1223–31.CrossRefPubMed
37.
Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990;264:2511–8.CrossRefPubMed
38.
39.
40.
Wolfe D, Carrieri MP, Shepard D. Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. Lancet. 2010;376:355–66.CrossRefPubMed
41.
Hinkin CH, Hardy DJ, Mason KI, Castellon SA, Durvasula RS, Lam MN, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS Lond. Engl. 2004;18:S19–25.
42.
Arnsten JH, Demas PA, Grant RW, Gourevitch MN, Farzadegan H, Howard AA, et al. Impact of Active Drug Use on Antiretroviral Therapy Adherence and Viral Suppression in HIV-infected Drug Users. J Gen Intern Med. 2002;17:377–81.CrossRefPubMedPubMedCentral
43.
44.
Uchino BN. Social support and health: a review of physiological processes potentially underlying links to disease outcomes. J Behav Med. 2006;29:377–87.CrossRefPubMed
45.
Persson L, Gullberg B, Hanson BS, Moestrup T, Ostergren PO. HIV infection: social network, social support, and CD4 lymphocyte values in infected homosexual men in Malmö, Sweden. J Epidemiol Community Health. 1994;48:580–5.CrossRefPubMedPubMedCentral
46.
Theorell T, Blomkvist V, Jonsson H, Schulman S, Berntorp E, Stigendal L. Social support and the development of immune function in human immunodeficiency virus infection. Psychosom Med. 1995;57:32–6.CrossRefPubMed
47.
Simoni JM, Frick PA, Huang B. A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol. Off. J. Div. Health Psychol. Am. Psychol. Assoc. 2006;25:74–81.
48.
Leserman J, Petitto JM, Golden RN, Gaynes BN, Gu H, Perkins DO, et al. Impact of Stressful Life Events, Depression, Social Support, Coping, and Cortisol on Progression to AIDS. Am J Psychiatry. 2000;157:1221–8.CrossRefPubMed
49.
Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004;130:601–30.CrossRefPubMedPubMedCentral
50.
Glaser R, Kiecolt-Glaser JK. Stress-induced immune dysfunction: implications for health. Nat Rev Immunol. 2005;5:243–51.CrossRefPubMed
51.
Bolger N, Foster M, Vinokur AD, Ng R. Close relationships and adjustment to a life crisis: the case of breast cancer. J Pers Soc Psychol. 1996;70:283–94.CrossRefPubMed
52.
Holahan CJ, Moos RH. Life stressors, resistance factors, and improved psychological functioning: an extension of the stress resistance paradigm. J Pers Soc Psychol. 1990;58:909–17.CrossRefPubMed
53.
Alegría M, Chatterji P, Wells K, Cao Z, Chen C, Takeuchi D, et al. Disparity in Depression Treatment Among Racial and Ethnic Minority Populations in the United States. Psychiatr Serv. 2008;59:1264–72.CrossRefPubMedPubMedCentral
54.
Born W, Greiner KA, Sylvia E, Butler J, Ahluwalia JS. Knowledge, attitudes, and beliefs about end-of-life care among inner-city African Americans and Latinos. J Palliat Med. 2004;7:247–56.CrossRefPubMed
55.
56.
Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24:1101–8.CrossRefPubMedPubMedCentral
57.
Sohler NL, Li X, Cunningham CO. Gender Disparities in HIV Health Care Utilization among the Severely Disadvantaged: Can We Determine the Reasons? AIDS Patient Care STDs. 2009;23:775–83.CrossRefPubMedPubMedCentral
58.
Hogan BE, Linden W, Najarian B. Social support interventions: Do they work? Clin Psychol Rev. 2002;22:381–440.CrossRef
59.
Kushel MB, Gupta R, Gee L, Haas JS. Housing Instability and Food Insecurity as Barriers to Health Care Among Low-Income Americans. J Gen Intern Med. 2006;21:71–7.CrossRefPubMedPubMedCentral
Metadata
Title
Perceived access and barriers to care among illicit drug users and hazardous drinkers: findings from the Seek, Test, Treat, and Retain data harmonization initiative (STTR)
Authors
Mika Matsuzaki
Quan M. Vu
Marya Gwadz
Joseph A. C. Delaney
Irene Kuo
Maria Esther Perez Trejo
William E. Cunningham
Chinazo O. Cunningham
Katerina Christopoulos
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5291-2

Other articles of this Issue 1/2018

BMC Public Health 1/2018 Go to the issue

Research article

Textual health warning labels on snus (Swedish moist snuff): do they affect risk perception?

Research article

The silent burden of stigmatisation: a qualitative study among Dutch people with a low socioeconomic position

Study protocol

Protocol for the CHORD project (community health outreach to reduce diabetes): a cluster-randomized community health worker trial to prevent diabetes

Research article

Exposure to second-hand tobacco smoke and respiratory symptoms in non-smoking adults: cross-sectional data from the general population of Telemark, Norway

Research article

Educational status and beliefs regarding non-communicable diseases among children in Ghana

Research article

A spatiotemporal mixed model to assess the influence of environmental and socioeconomic factors on the incidence of hand, foot and mouth disease