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1. Ending the HIV Epidemic in Metropolitan Atlanta: a mixed‐methods study to support the local HIV/AIDS response

Author

Micah Piske, Bohdan Nosyk, Justin C. Smith, Bianca Yeung, Benjamin Enns, Xiao Zang, Patrick S. Sullivan, Wendy S. Armstrong, Melanie A. Thompson, Gaea Daniel, and Carlos del Rio

Subjects
HIV epidemiology, HIV prevention, testing, PrEP, structural drivers, public health, Immunologic diseases. Allergy, RC581-607
Abstract

Abstract Introduction Four counties within the Atlanta, Georgia 20‐county eligible metropolitan area (EMA) are currently prioritized by the US “Ending the HIV Epidemic” (EHE) initiative which aims for a 90% reduction in HIV incidence by 2030. Disparities driving Atlanta's HIV epidemic warrant an examination of local service availability, unmet needs and organizational capacity to reach EHE targets. We conducted a mixed‐methods evaluation of the Atlanta EMA to examine geographic HIV epidemiology and distribution of services, service needs and organization infrastructure for each pillar of the EHE initiative. Methods We collected 2021 county‐level data (during June 2022), from multiple sources including: AIDSVu (HIV prevalence and new diagnoses), the Centers for Disease Control and Prevention web‐based tools (HIV testing and pre‐exposure prophylaxis [PrEP] locations) and the Georgia Department of Public Health (HIV testing, PrEP screenings, viral suppression and partner service interviews). We additionally distributed an online survey to key local stakeholders working at major HIV care agencies across the EMA to assess the availability of services, unmet needs and organization infrastructure (June−December 2022). The Organizational Readiness for Implementing Change questionnaire assessed the organization climate for services in need of scale‐up or implementation. Results We found racial/ethnic and geographic disparities in HIV disease burden and service availability across the EMA—particularly for HIV testing and PrEP in the EMA's southern counties. Five counties not currently prioritized by EHE (Clayton, Douglas, Henry, Newton and Rockdale) accounted for 16% of the EMA's new diagnoses, but

Published
2024
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2. Prevalence and Correlates of Reporting Difficulty Taking Antiretroviral Treatment Among HIV-Positive Illicit Drug Users in Vancouver, Canada: A Longitudinal Analysis

Author

Julio S. G. Montaner, Bianca Yeung, Eugenia Socías, Jeannie Shoveller, M-J Milloy, Huiru Dong, and N. A. Mohd Salleh

Subjects
Adult, Male, Canada, medicine.medical_specialty, Social Psychology, HIV Infections, Article, Medication Adherence, Drug Users, 03 medical and health sciences, 0302 clinical medicine, Health care, Prevalence, medicine, Humans, Longitudinal Studies, 030212 general & internal medicine, Prospective cohort study, 030505 public health, business.industry, Public health, Public Health, Environmental and Occupational Health, Odds ratio, Middle Aged, Health psychology, Infectious Diseases, Anti-Retroviral Agents, Pill, Family medicine, Cohort, Female, 0305 other medical science, business, Viral load
Abstract

BACKGROUND: People living with HIV who use illicit drugs continue to experience high rates of suboptimal treatment outcomes from antiretroviral therapy (ART). Although previous studies have identified important behavioural, social and structural barriers to ART adherence, the effects of patient-level factors have not been fully evaluated. Thus, we sought to investigate the prevalence and correlates of reporting ART was difficult to take among a cohort of illicit drug users in Vancouver, Canada. METHODS: We accessed data from the AIDS Care Cohort to evaluate Exposure to Survival Services (ACCESS), an ongoing prospective cohort of HIV-positive illicit drug users linked to comprehensive HIV clinical monitoring records. We used generalized linear mixed-effects modeling to identify factors longitudinally associated with periods in which individuals reported they found ART difficult to take. RESULTS: Between December 2005 and May 2014, 746 ART-exposed illicit drug users were recruited and contributed at least one study interview. Finding ART hard to take was reported by 209 (28.0%) participants at baseline, and 460 (61.7%) participants throughout the study period. Patients ingesting a greater daily pill count (Adjusted Odds Ratio [AOR] = 1.12 per pill, 95% Confidence Interval [CI]: 1.08–1.17) and experiencing barriers to healthcare (AOR = 1.64, 95% CI: 1.34–2.01) were more likely to report difficulty taking ART. Patients less likely to report satisfaction with their HIV physician (AOR = 0.76, 95% CI: 0.58–1.00) and achieve a non-detectable HIV viral load (AOR = 0.62, 95% CI: 0.51–0.74) were more likely to report finding ART hard to take. CONCLUSION: In this community-recruited cohort of ART-exposed illicit drug users, a substantial proportion reported they found HIV treatment hard to take, which was clearly linked to higher dissatisfaction with healthcare experiences and, most importantly, a lower likelihood of experiencing optimal virologic outcomes. Our findings reveal a number of opportunities to improve HIV treatment experiences and outcomes for people who use illicit drugs, including the use of treatment regimens with lower pill burdens, as well as reducing barriers to healthcare access.

Published
2018

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