Harry Jin1, Adedotun Ogunbajo2, Matthew J Mimiaga3, Dustin T Duncan4, Edward Boyer5, Peter Chai5, Samantha E Dilworth6, Adam W Carrico7. 1. Department of Epidemiology, Brown University School of Public Health, Box G-S121-2, 121 South Main Street, Providence, RI 02912 USA. 2. Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, 121 South Main Street, Providence, RI 02912 USA. 3. Department of Epidemiology, Brown University School of Public Health, Box G-S121-2, 121 South Main Street, Providence, RI 02912 USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, 121 South Main Street, Providence, RI 02912 USA. 4. Department of Population Health, New York University School of Medicine, Translational Research Building, 227 East 30th Street, Floor 7, New York, NY 10016 USA. 5. Brigham and Women's Hospital, Division of Medical Toxicology, Department of Emergency Medicine, 75 Francis Street, Boston Ma 02115 USA. 6. School of Medicine, University of California - San Francisco, 1600 Divisadero St., San Francisco, CA 94115 USA. 7. School of Medicine, University of California - San Francisco, 1600 Divisadero St., San Francisco, CA 94115 USA; Department of Public Health Sciences, University of Miami, 1120 NW 14th St., Office 1005, Miami, FL 33136 USA. Electronic address: a.carrico@miami.edu.
Abstract
BACKGROUND: HIV-positive persons who use stimulants such as methamphetamine experience greater difficulties in navigating the HIV care continuum. In the era of HIV treatment as prevention (TasP), little is known about the prevalence and correlates of success along the HIV care continuum among people who use stimulants. SETTING: San Francisco, California USA METHODS: Cross-sectional study that enrolled 129 HIV-positive men who have sex with men (MSM) from 2013 through 2017 who had biologically confirmed, recent methamphetamine use. Multivariable logistic regressions were built to identify correlates of success across the HIV care continuum. RESULTS: Although two-thirds (87/129) of participants had undetectable HIV viral load (<40 copies/mL), only one-in-four (32/129) reported taking at least 90% of their antiretroviral therapy (ART). Those who were homeless in the past year (adjusted odds ratio [aOR] = 0.20; 95% CI = 0.06-0.65) had 80% lower odds of being undetectable and adherent to ART. Substance use disorder treatment was associated with 77% lower odds of being engaged in HIV care (aOR = 0.23; 95% CI = 0.06-0.84) but also close to 3-fold greater odds of being adherent to ART (aOR = 2.91; 95% CI = 1.12-7.60). CONCLUSION: Despite the fact that many HIV-positive, methamphetamine-using MSM are able to achieve undetectable viral load in this sample, difficulties with ART adherence threaten to undermine the clinical and public health benefits of TasP. Expanded efforts to boost the effectiveness of TasP in this population should focus on meeting the unique needs of homeless individuals, optimizing ART adherence, and facilitating the integration of HIV care with substance use disorder treatment.
BACKGROUND: HIV-positive persons who use stimulants such as methamphetamine experience greater difficulties in navigating the HIV care continuum. In the era of HIV treatment as prevention (TasP), little is known about the prevalence and correlates of success along the HIV care continuum among people who use stimulants. SETTING:San Francisco, California USA METHODS: Cross-sectional study that enrolled 129 HIV-positive men who have sex with men (MSM) from 2013 through 2017 who had biologically confirmed, recent methamphetamine use. Multivariable logistic regressions were built to identify correlates of success across the HIV care continuum. RESULTS: Although two-thirds (87/129) of participants had undetectable HIV viral load (<40 copies/mL), only one-in-four (32/129) reported taking at least 90% of their antiretroviral therapy (ART). Those who were homeless in the past year (adjusted odds ratio [aOR] = 0.20; 95% CI = 0.06-0.65) had 80% lower odds of being undetectable and adherent to ART. Substance use disorder treatment was associated with 77% lower odds of being engaged in HIV care (aOR = 0.23; 95% CI = 0.06-0.84) but also close to 3-fold greater odds of being adherent to ART (aOR = 2.91; 95% CI = 1.12-7.60). CONCLUSION: Despite the fact that many HIV-positive, methamphetamine-using MSM are able to achieve undetectable viral load in this sample, difficulties with ART adherence threaten to undermine the clinical and public health benefits of TasP. Expanded efforts to boost the effectiveness of TasP in this population should focus on meeting the unique needs of homeless individuals, optimizing ART adherence, and facilitating the integration of HIV care with substance use disorder treatment.
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