Injection Drug Use and HIV Antiretroviral Therapy Discontinuation in A Canadian Setting

Werb, Dan; Milloy, M‐J; Kerr, Thomas; Zhang, Ruth; Montaner, Julio S. G.; Wood, Evan

doi:10.1007/s10461-012-0136-y

Cited by 21 publications

(14 citation statements)

References 28 publications

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“…A study conducted among PWID with current and histories of injection drug use in Denmark found ART adherence of less than 90% in 55% of PWID (defined by satisfying the 90% medication adherence and remaining in treatment to the end of the study evaluation) (31). A long term follow-up study among PWID with current and histories of injection drug use in Canada from 1996 through 2008 recruited over 400 HIV positive PWID, and only 63% remained adherent over the entire adherence analysis period (defined by satisfying the 90% medication adherence and remaining in treatment to the end of the study evaluation) (32). Among 350 PWID with current and histories of injection drug use that were analyzed as part of the ALIVE study in Baltimore (33), adherence was measured over a five year period of HIV treatment, and the results showed that only 26.7% of participants were compliant with ART therapy (defined by 90% of medication taken during follow-up periods) (34).…”

Section: Discussionmentioning

confidence: 99%

Adherence to Antiretroviral Medications Among Persons Who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

et al. 2014

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Adherence to antiretroviral (ART) medication is vital to reducing morbidity and mortality among HIV positive persons. People who inject drugs (PWID) are at high risk for HIV infection in transitional/low/middle income countries (TLMIC). We conducted a systematic review of studies reporting adherence to ARTs among persons with active injection drug use and/or histories of injection drug use in TLMIC. Meta-regression was performed to examine relationships between location, adherence measurements, and follow-up period. Fifteen studies were included from seven countries. Adherence levels ranged from 33% to 97%; mean weighted adherence was 72%. ART adherence was associated with different methods of measuring adherence and studies conducted in Eastern Europe and East Asia. The great heterogeneity observed precludes generalization to TLMIC as a whole. Given the critical importance of ART adherence more research is needed on ART adherence among PWID in TLMIC, including the use of standardized methods for reporting adherence to ARTs.

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Section: Discussionmentioning

confidence: 99%

Adherence to Antiretroviral Medications Among Persons Who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

et al. 2014

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“…No one refused to participate or dropped out of the study and participants were provided an honorarium ($30 CAD). Interviews were facilitated using an interview guide adapted from our previous qualitative studies with PLHIV who use drugs [41–43] and revised to focus on influences on ART adherence identified through analyses of ACCESS data [34, 44, 45]. Interviews were 20–70 min in length, audio recorded, and transcribed.…”

Section: Methodsmentioning

confidence: 99%

Antiretroviral Therapy Interruption Among HIV Postive People Who Use Drugs in a Setting with a Community-Wide HIV Treatment-as-Prevention Initiative

McNeil

Coleman

Maher³

et al. 2016

AIDS Behav

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HIV Treatment as Prevention (TasP) initiatives promote antiretroviral therapy (ART) access and optimal adherence (≥95 %) to produce viral suppression among people living with HIV (PLHIV) and prevent the onward transmission of HIV. ART treatment interruptions are common among PLHIV who use drugs and undermine the effectiveness of TasP. Semi-structured interviews were conducted with 39 PLHIV who use drugs who had experienced treatment ART interruptions in a setting with a community-wide TasP initiative (Vancouver, Canada) to examine influences on these outcomes. While study participants attributed ART interruptions to “treatment fatigue,” our analysis revealed individual, social, and structural influences on these events, including: (1) prior adverse ART-related experiences among those with long-term treatment histories; (2) experiences of social isolation; and, (3) breakdowns in the continuity of HIV care following disruptive events (e.g., eviction, incarceration). Findings reconceptualise ‘treatment fatigue’ by focusing attention on its underlying mechanisms, while demonstrating the need for comprehensive structural reforms and targeted interventions to optimize TasP among drug-using PLHIV.

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“…57 While research from North America has shown that optimal outcomes from ART can be achieved in prisons, 245 a large body of work from a range of settings shows that among PWID, incarceration is often strongly associated with poor access and adherence to ART, premature discontinuation of ART, and low rates of viral suppression. 246–249 It appears that problems ensuring access to ART and related care within North America occurs throughout the incarceration process (e.g., in detention, during transfers, at discharge), and low access and adherence is shaped by high rates of HIV-related stigma and concerns about breaches of privacy within prison systems. 246,250 (see web appendix VII).…”

Section: Drug-related Incarceration and Healthmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

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Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

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Injection Drug Use and HIV Antiretroviral Therapy Discontinuation in A Canadian Setting

Cited by 21 publications

References 28 publications

Adherence to Antiretroviral Medications Among Persons Who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

Adherence to Antiretroviral Medications Among Persons Who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

Antiretroviral Therapy Interruption Among HIV Postive People Who Use Drugs in a Setting with a Community-Wide HIV Treatment-as-Prevention Initiative

Public health and international drug policy

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