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Addict Sci Clin Pract. 2017 Dec 4;12(1):30. doi: 10.1186/s13722-017-0098-5.

Role of substance use in HIV care cascade outcomes among people who inject drugs in Russia.

Author information

1
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA.
2
Department of Infectious Diseases, Bashkir State Medical University, 3 Lenina St., Ufa, Bashkortostan Republic, Russian Federation, 450000.
3
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA.
4
Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118, USA.
5
First St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg, Russian Federation, 197022.
6
Data Coordinating Center, Boston University School of Public Health, 85 E Newton St M921, Boston, MA, 02118, USA.
7
HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, National Institute of Health, 5365 Fishers Lane, Bethesda, MD, 20892, USA.
8
Pasteur Research Institute of Epidemiology and Microbiology, Mira St. 14, St. Petersburg, Russian Federation, 197101.
9
St. Petersburg Bekhterev Research Psychoneurological Institute, Bekhtereva St., 3, St. Petersburg, Russian Federation, 192019.
10
Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA, 02118, USA. jsamet@bu.edu.
11
Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, USA. jsamet@bu.edu.

Abstract

BACKGROUND:

Engaging people who drink alcohol or inject drugs in HIV care can be challenging, particularly in Eastern Europe. Healthcare facilities in Russia are organized by specialty; therefore linking patients from addiction care to HIV hospitals has been difficult. The HIV care cascade outlines stages of HIV care (e.g., linkage to care, prescribed antiretroviral therapy [ART], and achieving HIV viral suppression). We hypothesized that unhealthy alcohol use, injection drug use, and opioid craving are associated with unfavorable HIV care cascade outcomes.

METHODS:

We analyzed data from a cohort (n = 249) of HIV-positive Russians who have been in addiction hospital treatment in the past year and had a lifetime history of injection drug use (IDU). We evaluated the association between unhealthy alcohol use (AUDIT score > 7 [both hazardous drinking and dependence]), past-month injection drug use (IDU), and opioid craving (visual analogue scale from 1 to 100) with HIV care cascade outcomes. The primary outcome was linkage to HIV care within 12 months. Other outcomes were prescription of ART (secondary) and achievement of undetectable HIV viral load (HVL < 500 copies/mL) within 12 months (exploratory); the latter was analyzed on a subset in which HVL was measured (n = 48). We assessed outcomes via medical record review (linkage, ART) and serum tests (HVL). To examine the primary outcome, we used multiple logistic regression models controlling for potential confounders.

RESULTS:

Among 249 study participants, unhealthy alcohol use (n = 148 [59%]) and past-month IDU (n = 130 [52%]) were common. The mean opioid craving score was 49 (SD: 38). We were unable to detect significant associations between the independent variables (i.e., unhealthy alcohol use, IDU and opioid craving) and any HIV care cascade outcomes in unadjusted and adjusted analyses.

CONCLUSION:

In this cohort of HIV-positive Russians with a history of IDU, individual substance use factors were not significantly associated with achieving HIV care cascade milestones (i.e., linkage to HIV care; prescription for ART; or suppressed viral load). Given no detection of an association of cascade outcomes with recent unhealthy use of alcohol or injection drugs in this cohort, examining systemic factors to understand determinants of HIV care engagement for people with drug use would be important.

KEYWORDS:

ART; HIV care cascade; Injection drug use; Linkage to care; Opioid craving; Russia; Suppressed viral load; Unhealthy alcohol use

PMID:
29198185
PMCID:
PMC5713116
DOI:
10.1186/s13722-017-0098-5
[Indexed for MEDLINE]
Free PMC Article

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