Never in Care: Characteristics of HIV-Infected Crack Cocaine Users in 2 US Cities Who Have Never Been to Outpatient HIV Care

Abstract

Background There are very limited data available of the correlates of HIV-infected crack users who have never been to HIV care. Methods Interviews were conducted at bedside with HIV-infected crack cocaine users who were recruited from the inpatient wards at Jackson Memorial Hospital in Miami, FL and Grady Memorial Hospital in Atlanta, GA between August 2006 and July 2009. Participants were asked about their socio-demographic characteristics, drug use, drug/alcohol treatment history, use of HIV care, perceived social support, and mental health status. Multiple logistic regression was performed to identify factors associated with never having been to HIV care. Results Among 355 study participants, 21% reported never having been to a doctor or clinic for HIV care. Higher adjusted odds of never having been in care were associated with an annual income of less than $5,000 (AOR=8.17, 95% CI=3.35–19.94, residence in Atlanta compared to Miami (AOR=2.57, 95% CI=1.36–4.83), no history of drug treatment (AOR=4.13, 95% CI=2.24,7.62) and not being helped into care at the time of HIV diagnosis (AOR=2.83, 95% CI=1.56,5.15). Conclusions Our data show that a significant proportion of HIV-infected crack cocaine users in two city hospitals have never been to HIV care. Interventions at the time of HIV diagnosis and drug treatment participation may facilitate linkage to care.

Evolução do consumo de crack em coorte com histórico de tratamento

“…Regarding HIV, it is recommended that users be referred to testing and follow-up facilities and undergo constant monitoring of their adherence to antiretroviral treatment and of their motivation to care for their health and body. 2 With the exception of a positive correlation with safe sexual behavior (condom use), we were unable to identify other factors associated with stability of abstinence trajectories. Notwithstanding, the composition of a group of long-abstinent subjects (group 1) indicated the rupture of skepticism with respect to the impossibility of overcoming crack cocaine addiction and sustaining abstinence for an extended period.…”

A Community-Based Study of Barriers to HIV Care Initiation

“…The CDC's HIV Prevention Strategic Plan has promoted the strengthening of linkages between diagnosis and care since 2001 41 and funded the Never in Care Pilot Project 24 and ARTAS studies to address this issue. Our study, along with the study by Bell and colleagues, 19 suggests that improvements in posttest linkages to care remain an area of needed improvement. Interestingly, we found very limited evidence of differences between study groups by testing location, which is different from other studies.…”

“…The absence of direct linkages between the HIV diagnosis and care initiation has been documented in just a few other studies. 9,11,19 Most recently, Bell et al 19 found that among a sample of hospitalized, HIVpositive crack cocaine users 40% did not report being helped into care since their HIV diagnosis, and these patients were significantly less likely to have ever been in HIV care than those who reported help getting into care. The CDC's HIV Prevention Strategic Plan has promoted the strengthening of linkages between diagnosis and care since 2001 41 and funded the Never in Care Pilot Project 24 and ARTAS studies to address this issue.…”

“…Two studies elsewhere found that: (1) 28% of facility and population-recruited HIV-positive persons from 18 states did not enter HIV treatment within 3 months 18 and (2) 21% of hospitalized HIV-positive crack cocaine smokers in Miami and Atlanta had never been to a doctor or clinic for HIV care, even though two thirds had received their diagnosis more than 5 years ago. 19 Such disparities and delays in care perpetuate avoidable morbidity, mortality, and costly medical care [20][21][22][23] as well as HIV transmission. 6 The Centers for Disease Control and Prevention (CDC) is currently implementing a population-based system to estimate the number of persons diagnosed with HIV who have not initiated care, identify their reasons for delaying care and provide regional population comparisons.…”

A Pilot Feasibility and Acceptability Study of Yoga/Meditation on the Quality of Life and Markers of Stress in Persons Living with HIV Who Also Use Crack Cocaine

“…However, research on these increasingly popular nonpharmacologic medical interventions in PLWH remains limited. Furthermore, compared with PLWH who are not substance users, the subpopulation of PLWH who use crack cocaine is typically more socioeconomically unstable and has a greater tendency to be unemployed, to be homeless, 40 and to have legal problems and stints in detention. As a result this group is more difficult to follow.…”