Historique
Article de Périodique
Human Immunodeficiency Virus Infection in intravenous drug users: a model for primary care (1992)
(Infection VIH chez les toxicomanes par voie intraveineuse: modèle de soin primaire)
Auteur(s) :
O'CONNOR, P. G. ;
MOLDE S. ;
HENRY, S. ;
SHOCKCOR W.T. ;
SCHOTTEN FELD R.S.
Année
1992
Page(s) :
382-385
Langue(s) :
Anglais
Refs biblio. :
15
Domaine :
Drogues illicites / Illicit drugs
Résumé :
FRANÇAIS :
Expérience de prise en charge prophylaxique et thérapeutique de toxicomanes séropositifs à New Haven - Connecticut. Le recrutement des patients s'est fait à partir d'un centre de sevrage de toxicomanes comportant un programme de méthadone et situé à proximité. Le but était d'effectuer un dépistage des infections associées à la toxicomanie et la séropositivité, et d'en réaliser le traitement en évaluant la compliance. Un dépistage de l'hépatite B, la syphilis, la tuberculose a ainsi été proposé associé à un dosage des CD4.
ENGLISH :
Purpose: Intravenous drug users (IVDUs) often encounter barriers to primary care. To improve access, we developed a primary care clinic—Central Medical Unit (CMU)—for substance abusers in drug treatment. We report outcomes for services offered to IVDUs with human immunodeficiency virus (HIV) infection.
Patients and methods: During 1990, 24% (120 of 509) of IVDUs eligible for CMU were HIV positive. Diagnostic therapeutic and preventive goals for IVDUs with HIV infection were evaluated for acceptance and compliance by chart review for these 120 patients.
Results: On admission, 65% (78 of 120) of patients reported having no source of primary care, 64% (77 of 120) were male, and 77% (92 of 120) were in methadone maintenance. All were screened for tuberculosis, syphilis, and hepatitis; 94% (15 of 16) of eligible patients accepted tuberculosis prophylaxis and 83% (5 of 6) accepted syphilis treatment, but only 36% (5 of 14) accepted hepatitis B vaccine. Of those who accepted therapy, 87% (13 of 15) were compliant with tuberculosis prophylaxis, and 100% (5 of 5) were compliant with syphilis treatment. Influenza vaccine was accepted by 49% (59 of 120) and pneumococcal vaccine by 81% (97 of 120). Ninety-eight percent (118 of 120) accepted T-cell testing: 61% had T-helper counts less than 500/mm3 and 25% were less than 200/mm3. Of those eligible, 89% (70 of 79) accepted antiretroviral therapy, and 100% (35 of 35) accepted Pneumocystis carinii pneumonia prophylaxis. Six-month compliance rates for these therapies were 84% (59 of 70) and 77% (27 of 35), respectively.
Conclusion: By offering primary care services with drug treatment, the CMU model may be an effective way of providing access to primary care for HIV-infected IVDUs and for facilitating compliance.
Expérience de prise en charge prophylaxique et thérapeutique de toxicomanes séropositifs à New Haven - Connecticut. Le recrutement des patients s'est fait à partir d'un centre de sevrage de toxicomanes comportant un programme de méthadone et situé à proximité. Le but était d'effectuer un dépistage des infections associées à la toxicomanie et la séropositivité, et d'en réaliser le traitement en évaluant la compliance. Un dépistage de l'hépatite B, la syphilis, la tuberculose a ainsi été proposé associé à un dosage des CD4.
ENGLISH :
Purpose: Intravenous drug users (IVDUs) often encounter barriers to primary care. To improve access, we developed a primary care clinic—Central Medical Unit (CMU)—for substance abusers in drug treatment. We report outcomes for services offered to IVDUs with human immunodeficiency virus (HIV) infection.
Patients and methods: During 1990, 24% (120 of 509) of IVDUs eligible for CMU were HIV positive. Diagnostic therapeutic and preventive goals for IVDUs with HIV infection were evaluated for acceptance and compliance by chart review for these 120 patients.
Results: On admission, 65% (78 of 120) of patients reported having no source of primary care, 64% (77 of 120) were male, and 77% (92 of 120) were in methadone maintenance. All were screened for tuberculosis, syphilis, and hepatitis; 94% (15 of 16) of eligible patients accepted tuberculosis prophylaxis and 83% (5 of 6) accepted syphilis treatment, but only 36% (5 of 14) accepted hepatitis B vaccine. Of those who accepted therapy, 87% (13 of 15) were compliant with tuberculosis prophylaxis, and 100% (5 of 5) were compliant with syphilis treatment. Influenza vaccine was accepted by 49% (59 of 120) and pneumococcal vaccine by 81% (97 of 120). Ninety-eight percent (118 of 120) accepted T-cell testing: 61% had T-helper counts less than 500/mm3 and 25% were less than 200/mm3. Of those eligible, 89% (70 of 79) accepted antiretroviral therapy, and 100% (35 of 35) accepted Pneumocystis carinii pneumonia prophylaxis. Six-month compliance rates for these therapies were 84% (59 of 70) and 77% (27 of 35), respectively.
Conclusion: By offering primary care services with drug treatment, the CMU model may be an effective way of providing access to primary care for HIV-infected IVDUs and for facilitating compliance.
Affiliation :
Department of Medicine, Yale University School of Medicine and Central Medical Unit/APT Foundation, New Haven, Connecticut, USA