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AIDS Behav. 2019 May;23(5):1258-1266. doi: 10.1007/s10461-018-2226-y.

Engagement in Maximally-Assisted Therapy and Adherence to Antiretroviral Therapy Among a Cohort of Indigenous People Who Use Illicit Drugs.

Author information

1
British Columbia Centre on Substance Use, Vancouver, Canada.
2
Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada.
3
First Nations Health Authority, BC Provincial Government, Vancouver, Canada.
4
Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada.
5
School of Public Policy, Simon Fraser University, Vancouver, Canada.
6
School of Population and Public Health, University of British Columbia, Vancouver, Canada.
7
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
8
British Columbia Centre on Substance Use, Vancouver, Canada. bccsu-mjsm@bccsu.ubc.ca.
9
Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada. bccsu-mjsm@bccsu.ubc.ca.

Abstract

Throughout the world, Indigenous populations experience a disproportionate burden of HIV infection. Maximally-assisted therapy (MAT) is an interdisciplinary care intervention that includes ART dispensation to support individuals with a history of addiction and homelessness. This study sought to longitudinally evaluate the relationship between engagement in MAT and achieving optimal adherence using data from an ongoing cohort of HIV-positive individuals who use drugs in Vancouver, Canada, where HIV/AIDS treatment is offered at no cost. Between December 2005 and November 2016, 354 HIV-positive Indigenous participants were enrolled and data were analyzed using generalized mixed-effects (GLMM) and marginal structural modeling. In both multivariable analyses, engagement in MAT was independently associated with optimal adherence to ART (GLMM: AOR = 4.92, 95% CI 3.18-7.62; marginal structural model: AOR = 5.76, 95% CI 3.34-9.96). MAT-based programmes could be a part of a renewed evidence-base to elevated levels of preventable HIV/AIDS-associated morbidity, mortality and viral transmission among Indigenous peoples in Canada.

KEYWORDS:

Antiretroviral therapy; Canada; HIV; HIV interventions; Indigenous people; People who use drugs

PMID:
30269233
PMCID:
PMC6440861
[Available on 2020-05-01]
DOI:
10.1007/s10461-018-2226-y

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