The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #71243

Yves Jude Jeanty, MPH¹, Lisa R. Metsch, PhD², James Dean Wilkinson, PhD², and Clyde B. McCoy, PhD³. (1) Epidemiology & Public Health, University of Miami, 1800 NW 9 Avenue, Suite 300, Miami, FL 33136, 305-243-6348, yjeanty@med.miami.edu, (2) Department of Epidemiology and Public Health, University of Miami School of Medicine, 1801 NW. 9th Avenue, Suite 313, Miami, FL 33136, (3) Department of Epidemiology and Public Health, University of Miami, 1801 NW 9th Ave (D-93), Miami, FL 33136

Background: The HIV/AIDS burden remains disproportionately large in the substance abusing population. Injection drug use has accounted for 25%, of all United States AIDS cases. HIV+ substance users exhibit lesser rates of health care access, utilization and HAART adherence. This study investigates critical factors influencing adherence: demographic variables, health care access/utilization, and the patient-provider relationship, as they pertain to a HAART prescribed, substance-abusing population recruited from Miami.

Methods: 130 HIV+, injecting drug users (IDUs) and chronic drug users (CDUs) were recruited through snowball sampling between 1998 and 2000. Study participants completed a questionnaire eliciting salient beliefs and behavior regarding access and use of HIV care, perception of health, patient-provider relationship, and medication taking behaviors during the previous twelve month period.

Results: Forty-nine percent of the sample reported 90% or greater adherence. 90% or greater adherence was significantly associated with the following characteristics: they were more likely to report being very satisfied in their relationship with their physician (O.R.=2.96), had more physician appointments related to HIV during the previous twelve months (O.R.=1.56), and allowed less time to elapse between their initial diagnosis and their first medical consultation (O.R.=0.58).

Conclusions: Interventions designed to increase adherence rates should target the patient-provider relationship. HIV+ substance abusers less likely to use the health care system might benefit from interventions promoting consistent health care utilization, resource availability and skill sets to improve communication with health providers. Provider-centered sensitivity training could improve interaction with marginalized HIV+ populations thereby increasing patient trust, understanding and ultimately, HAART adherence.

Learning Objectives:

• 1) To stress the importance of improving the communication between patient and provider particularly in light of the stringent medication and wellness regimen requirements associated with long term HIV care.
• 2) To discuss the limitations of the current treatment model for long term HIV care in addressing a substance abusing population.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.