Barriers to injection drug users' uptake of highly active antiretroviral therapy (HAART): The role of patient-provider communication and drug-related attitudes about HAART

Background: Active injection drug users (IDUs) compared to other HIV+ populations have lower access to highly active antiretroviral therapies (HAART) and lower HAART uptake even when financial barriers are reduced. The study sought to identify factors additional to structural and lifestyle factors that influence IDUs' HAART use. Results will inform multi-level, culturally tailored interventions to improve IDUs' HAART uptake. Methods: Participants were enrolled in the INSPIRE study, a multisite trial of an HIV prevention intervention (Purcell, et al., 2004). Study eligibility included prior year IDU and heterosexual sex. The general estimating equation method was used to estimate parameter values in a logistic regression model of baseline and 6-months factors predicting HAART use at 6- and 12-months follow-up, respectively. Results: The sample (n=1051) comprised 63% males, 75% current drug users, 74% Blacks, and 60% CD4 count<350. Results indicated that taking HAART was predicted by better patient-provider communication (Bakken, et al., 2000) and not strongly disagreeing that taking HAART “keeps you healthy even if you're taking street drugs,” as were no current drug use, stable housing, medical visits, CD4 count, medical coverage, and male sex. Depression and drug abuse treatment were not significant. Conclusions: The findings suggest that communication skills building targeting active IDUs and their health care providers is an important strategy for improving IDUs' HAART uptake, and that IDUs' HAART training should be tailored to the context of their drug use. Interventions also ought to promote their stable housing, medical coverage, and primary health care use, especially among female IDUs.