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Improvements in HIV treatment outcomes among indigenous and non-indigenous people who use illicit drugs in a Canadian setting.

Milloy MJ, King A, Kerr T, Adams E, Samji H, Guillemi S, Wood E, Montaner J - J Int AIDS Soc (2016)

Bottom Line: In multivariable models, later interview period was positively associated with recent ART (adjusted odds ratio (AOR) = 1.16 per interview period, 95% confidence interval (CI): 1.11 to 1.20) and non-detectable VL (AOR = 1.07, 95% CI: 1.04 to 1.10).In adjusted models comparing indigenous and non-indigenous participants, we did not observe differences between the two groups (all p>0.1).In this large and long-term study involving community-recruited HIV-positive illicit drug users, we observed a substantial and increasing proportion of indigenous participants reach several important thresholds in HIV care at rates indistinguishable from non-indigenous participants.

View Article: PubMed Central - PubMed

Affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.

ABSTRACT

Introduction: In many settings worldwide, members of indigenous groups experience a disproportionate burden of HIV. In Canada, there is an urgent need to improve HIV treatment outcomes for indigenous people living with HIV (IPLWH), to not only reduce HIV/AIDS-associated morbidity and mortality but also curb elevated rates of viral transmission. Thus, by comparing indigenous and non-indigenous participants in an ongoing longitudinal cohort of HIV-positive people who use illicit drugs, we sought to investigate longitudinal changes in three HIV treatment indicators for IPLWH who use illicit drugs during a community-wide treatment-as-prevention (TasP) initiative in British Columbia, Canada.

Methods: We used data from the ACCESS study, an ongoing observational prospective cohort of HIV-positive illicit drug users recruited from community settings in Vancouver, British Columbia. Cohort data are linked to comprehensive retrospective and prospective clinical records in a setting of no-cost HIV/AIDS treatment and care. We used multivariable generalized estimating equations (GEE) to evaluate longitudinal changes in the proportion of participants with exposure to antiretroviral therapy (ART) in the previous 180 days, optimal adherence to ART (i.e. ≥ 95% vs. < 95%) and non-detectable HIV-1 RNA viral load (VL <50 copies/mL plasma).

Results: Between 2005 and 2014, 845 individuals were recruited, including 326 (39%) self-reporting any indigenous ancestry, and contributed 6732 interviews and 13,495 VL measurements. Among indigenous participants, the proportion with recent ART increased from 51 to 94% and non-detectable VL from 23 to 65%. In multivariable models, later interview period was positively associated with recent ART (adjusted odds ratio (AOR) = 1.16 per interview period, 95% confidence interval (CI): 1.11 to 1.20) and non-detectable VL (AOR = 1.07, 95% CI: 1.04 to 1.10). In adjusted models comparing indigenous and non-indigenous participants, we did not observe differences between the two groups (all p>0.1).

Conclusions: In this large and long-term study involving community-recruited HIV-positive illicit drug users, we observed a substantial and increasing proportion of indigenous participants reach several important thresholds in HIV care at rates indistinguishable from non-indigenous participants. The current findings highlight the important role of TasP on vulnerable populations in this setting and contribute to the evidence base supporting the immediate scale-up of ART to address HIV/AIDS-associated morbidity, mortality and viral transmission.

No MeSH data available.


Related in: MedlinePlus

HIV/AIDS treatment outcomes, 2005 to 2014. Proportion, with 95% confidence interval, of participants with ≥1 day of ART in the previous six months (top); ≥95% adherence to ART (middle); and plasma HIV-1 RNA load <50 copies/mL (bottom) stratified by indigenous (dark grey) and non-indigenous (light grey) ancestry.
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Figure 0001: HIV/AIDS treatment outcomes, 2005 to 2014. Proportion, with 95% confidence interval, of participants with ≥1 day of ART in the previous six months (top); ≥95% adherence to ART (middle); and plasma HIV-1 RNA load <50 copies/mL (bottom) stratified by indigenous (dark grey) and non-indigenous (light grey) ancestry.

Mentions: Figure 1 depicts the changes over time in the proportion of participants experiencing each HIV treatment threshold. At the first interview period, 51% of all participants had been dispensed ≥1 day of ART in the previous 180 days; at the final interview period, 94% had been recently dispensed ART. Similarly, the proportion of all participants attaining ≥95% adherence in the previous 180 days was 45% at the first interview period; at the final interview period, the proportion was 61%. Finally, 56% of all individuals had non-detectable plasma VL at the final interview period, an increase of 32 percentage points since the first interview period.


Improvements in HIV treatment outcomes among indigenous and non-indigenous people who use illicit drugs in a Canadian setting.

Milloy MJ, King A, Kerr T, Adams E, Samji H, Guillemi S, Wood E, Montaner J - J Int AIDS Soc (2016)

HIV/AIDS treatment outcomes, 2005 to 2014. Proportion, with 95% confidence interval, of participants with ≥1 day of ART in the previous six months (top); ≥95% adherence to ART (middle); and plasma HIV-1 RNA load <50 copies/mL (bottom) stratified by indigenous (dark grey) and non-indigenous (light grey) ancestry.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837333&req=5

Figure 0001: HIV/AIDS treatment outcomes, 2005 to 2014. Proportion, with 95% confidence interval, of participants with ≥1 day of ART in the previous six months (top); ≥95% adherence to ART (middle); and plasma HIV-1 RNA load <50 copies/mL (bottom) stratified by indigenous (dark grey) and non-indigenous (light grey) ancestry.
Mentions: Figure 1 depicts the changes over time in the proportion of participants experiencing each HIV treatment threshold. At the first interview period, 51% of all participants had been dispensed ≥1 day of ART in the previous 180 days; at the final interview period, 94% had been recently dispensed ART. Similarly, the proportion of all participants attaining ≥95% adherence in the previous 180 days was 45% at the first interview period; at the final interview period, the proportion was 61%. Finally, 56% of all individuals had non-detectable plasma VL at the final interview period, an increase of 32 percentage points since the first interview period.

Bottom Line: In multivariable models, later interview period was positively associated with recent ART (adjusted odds ratio (AOR) = 1.16 per interview period, 95% confidence interval (CI): 1.11 to 1.20) and non-detectable VL (AOR = 1.07, 95% CI: 1.04 to 1.10).In adjusted models comparing indigenous and non-indigenous participants, we did not observe differences between the two groups (all p>0.1).In this large and long-term study involving community-recruited HIV-positive illicit drug users, we observed a substantial and increasing proportion of indigenous participants reach several important thresholds in HIV care at rates indistinguishable from non-indigenous participants.

View Article: PubMed Central - PubMed

Affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.

ABSTRACT

Introduction: In many settings worldwide, members of indigenous groups experience a disproportionate burden of HIV. In Canada, there is an urgent need to improve HIV treatment outcomes for indigenous people living with HIV (IPLWH), to not only reduce HIV/AIDS-associated morbidity and mortality but also curb elevated rates of viral transmission. Thus, by comparing indigenous and non-indigenous participants in an ongoing longitudinal cohort of HIV-positive people who use illicit drugs, we sought to investigate longitudinal changes in three HIV treatment indicators for IPLWH who use illicit drugs during a community-wide treatment-as-prevention (TasP) initiative in British Columbia, Canada.

Methods: We used data from the ACCESS study, an ongoing observational prospective cohort of HIV-positive illicit drug users recruited from community settings in Vancouver, British Columbia. Cohort data are linked to comprehensive retrospective and prospective clinical records in a setting of no-cost HIV/AIDS treatment and care. We used multivariable generalized estimating equations (GEE) to evaluate longitudinal changes in the proportion of participants with exposure to antiretroviral therapy (ART) in the previous 180 days, optimal adherence to ART (i.e. ≥ 95% vs. < 95%) and non-detectable HIV-1 RNA viral load (VL <50 copies/mL plasma).

Results: Between 2005 and 2014, 845 individuals were recruited, including 326 (39%) self-reporting any indigenous ancestry, and contributed 6732 interviews and 13,495 VL measurements. Among indigenous participants, the proportion with recent ART increased from 51 to 94% and non-detectable VL from 23 to 65%. In multivariable models, later interview period was positively associated with recent ART (adjusted odds ratio (AOR) = 1.16 per interview period, 95% confidence interval (CI): 1.11 to 1.20) and non-detectable VL (AOR = 1.07, 95% CI: 1.04 to 1.10). In adjusted models comparing indigenous and non-indigenous participants, we did not observe differences between the two groups (all p>0.1).

Conclusions: In this large and long-term study involving community-recruited HIV-positive illicit drug users, we observed a substantial and increasing proportion of indigenous participants reach several important thresholds in HIV care at rates indistinguishable from non-indigenous participants. The current findings highlight the important role of TasP on vulnerable populations in this setting and contribute to the evidence base supporting the immediate scale-up of ART to address HIV/AIDS-associated morbidity, mortality and viral transmission.

No MeSH data available.


Related in: MedlinePlus