| Titre : | Barriers to use of free antiretroviral therapy in injection drug users |
| Titre traduit : | (Obstacles à la mise en place d'une thérapie antirétrovirale gratuite chez des usagers de drogues par voie intraveineuse) |
| Auteurs : | S. A. STRATHDEE ; A. PALEPU ; P. G. A. CORNELISSE ; B. YIP ; M. V. O'SHAUGHNESSY ; J. S. MONTANER ; M. T. SCHECHTER ; R. S. HOGG |
| Type de document : | Périodique |
| Année de publication : | 1998 |
| Format : | 547-549 |
| Note générale : |
Journal of the American Medical Association, 1998, 280, (6), 547-549 |
| Langues: | Français |
| Discipline : | MAL (Maladies infectieuses / Infectious diseases) |
| Mots-clés : |
Thésaurus mots-clés USAGER ; VOIE INTRAVEINEUSE ; VIH ; INFECTION ; ETUDE PROSPECTIVE ; COHORTE ; PRISE EN CHARGE ; TRAITEMENT ; EPIDEMIOLOGIEThésaurus géographique CANADA |
| Résumé : |
ENGLISH : CONTEXT: In British Columbia, human immunodeficiency virus (HIV)-infected persons eligible for antiretroviral therapy may receive it free but the extent to which HIV-infected injection drug users access it is unknown. OBJECTIVE: To identify patient and physician characteristics associated with antiretroviral therapy utilization in HIV-infected injection drug users. DESIGN: Prospective cohort study with record linkage between survey data and data from a provincial HIV/AIDS (acquired immunodeficiency syndrome) drug treatment program. SETTING: British Columbia, where antiretroviral therapies are offered free to all persons with HIV infection with CD4 cell counts less than 0.50 x 10(9)/L (500/microL) and/or HIV-1 RNA levels higher than 5000 copies/mL. SUBJECTS: A total of 177 HIV-infected injection drug users eligible for antiretroviral therapy, recruited through the prospective cohort study since May 1996. MAIN OUTCOME MEASURES: Patient use of antiretroviral drugs through the provincial drug treatment program and physician experience treating HIV infection. RESULTS: After a median of 11 months after first eligibility, only 71 (40%) of 177 patients had received any antiretroviral drugs, primarily double combinations (47/71 [66%]). Both patient and physician characteristics were associated with use of antiretroviral drugs. After adjusting for CD4 cell count and HIV-1 RNA level at eligibility, odds of not receiving antiretrovirals were increased more than 2-fold for females (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.08-5.93) and 3-fold for those not currently enrolled in drug or alcohol treatment programs (OR, 3.49; 95% CI, 1.45-8.40). Younger drug users were less likely to receive therapy (OR, 0.47/10-y increase; 95% CI, 0.28-0.80). Those with physicians having the least experience treating persons with HIV infection were more than 5 times less likely to receive therapy (OR, 5.55; 95% CI, 2.49-12.37). CONCLUSIONS: Despite free antiretroviral therapy, many HIV-infected injection drug users are not receiving it. Public health efforts should target younger and female drug users, and physicians with less experience treating HIV infection. (Review' s abstract) |
| Domaine : | Drogues illicites / Illicit drugs |
| Refs biblio. : | 21 |
| Affiliation : |
British Columbia Ctre for Excellence in HIV/AIDS, St Paul's Hospital Canada. Canada. |
| Numéro Toxibase : | 1300866 |
| Centre Emetteur : | 13 OFDT |
| Cote : | A01627 |
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