Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #109515

David Abramson, MPH, MPhil, Department of Sociomedical Sciences, Columbia University, 722 West 168th Street, room 1106, New York, NY 10032 and Peter A. Messeri, MA, PhD, Center for Applied Public Health, Joseph L. Mailman School of Public Health of Columbia University, 722 West 168th Street, Rm 1119, New York, NY 10032, (212) 305-1549, pam9@columbia.edu.

Background

HIV-positive substance users tend to experience poorer health outcomes than do non-substance users living with HIV. Apart from the individual choices that substance users make – such as a reluctance to access medical care in a timely fashion, remain engaged with medical care, or comply with treatment – drug users are often subject to social inequalities, social exclusion, and social instability. This study advances a conceptual model that distinguishes between individual and contextual influences on HIV treatment success. In this approach, treatment success may be understood as a function of clinical/practice factors, such as medication regimens (e.g., more tolerable non nucleoside reverse transcriptase inhibitor-based [NNRTI] regimens versus more resilient protease inhibitor [PI] based regimens) and comprehensive medical care; individual factors, such as drug and sex risk behaviors and adherence; and social/ contextual factors, within which are included structural social inequalities (race/ethnicity, education, gender, and income), social exclusion (stigma, weak social networks, poor mental health, and neighborhood disadvantage), and social instability (housing instability and chaotic daily routines).

Methods

We analyzed HIV treatment success among 1,742 HIV-positive adults participating in three randomly-sampled longitudinal cohort studies of HIV-positive adults in the New York metropolitan area. Data were collected between 1998-2004 using a structured in-person survey instrument. Among the respondents, 396 are current drug users (22.7%), 895 are former drug users (51.4%), and 451 have never used drugs or alcohol to excess (25.9%). We characterized subjects by medication regimen (none, PI-based, NNRTI-based, NRTI-based), and constructed a measure of treatment success based upon changes in CD4 and viral load levels from one interview round to the next.

Results

Regardless of medication regimen, current substance users on antiretroviral therapy were statistically significantly less likely to report viral suppression than were non-substance users or former users. Although there was slightly better treatment success for NNRTI-based regimens there was also a larger drop-off towards failure among non-adherents. Lastly, we conducted a series of chi-square analyses examining the impact of individual, clinical/practice, and social/cultural factors on HIV treatment success. Black and Latino respondents were less likely to report treatment success, as were those less educated, with lower income, unemployed, and younger. Additionally, respondents who reported poor patient-provider communication and medical care that was less than comprehensive also had lower rates of treatment success.

Conclusions

Consistent with a social disparities model, social advantage is associated with treatment success, as are such positive clinical factors as good provider communication and optimal care.

Learning Objectives: Participants in the session will

(
• learn how to assess health outcomes using a social disparities model; (
• develop an understanding of measuring HIV treatment success using virologic and immunological markers; (
• gain a better understanding of the use of specific medication regimens among marginalized populations such as substance users; and (
• learn about the relative contribution of individual and social factors to treatment success.

Keywords: HIV/AIDS, Outcomes Research

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation