Page 1 Social and socio-economic benefits of antiretroviral therapy adherence among HIV-infected people who use illicit drugs in Vancouver, Canada Lindsey.

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Presentation transcript:

Page 1 Social and socio-economic benefits of antiretroviral therapy adherence among HIV-infected people who use illicit drugs in Vancouver, Canada Lindsey Richardson, Thomas Kerr, Robert Hogg, Sylivia Guillemi, Julio Montaner, Evan Wood and M-J Milloy British Columbia Centre for Excellence in HIV/AIDS 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention Vancouver, 21 July 2015

Page 2 I have no conflicts of interest to declare Conflict of interest declaration

Page 3 Non-detectable viral load, stalled disease progression, reduced comorbidities Life expectancy approaches non-HIV+ for people optimally maintained on ART Sustained and significant population-level decreases in onward HIV transmission from ART scale up What about secondary clinical and non- clinical benefits of ART? Background Clinical benefits of ART adherence Nosyk et al. (2013) Lancet ID; Montaner et al., (2014) Plos One

Page 4 Entering employment Ceasing involvement in prohibited income generation Study objectives: To examine whether becoming optimally adherent to ART is associated with improvements in a range of social, socio-economic and secondary clinical outcomes among people who use illicit drugs Outcomes examined: Study Aims ≥95% adherence to ART Intimate relationship Initiation Transitioning out of homelessness Addiction treatment enrollment

Page 5 AIDS Care Cohort to Evaluate Access to Survival Services (ACCESS) Research design: Community-recruited cohort of people living with HIV/AIDS who use illicit drugs (ongoing since 1996) Data collection: Interviewer administered questionnaire and blood sample for serologic analysis at baseline and semi-annually Data linkages: Complete retrospective and prospective HIV clinical profile including all VL and ART dispensation from provincial treatment provider (BCCfE Drug Treatment Program) Methods: -Generalized linear mixed effects models for each outcome -Backwards model selection with adjustment for known/hypothesized confounders Data and Methods

Page 6 ACCESS Sample and Baseline Characteristics Results (1)

Page 7 Multivariate results Results (2)

Page 8 Prohibited IGA, ART adherence and VL Conclusions ART adherence increases the likelihood of reducing socio-economic vulnerability: -Ceasing prohibited income generation -Transitioning out of homelessness Improved socio-economic well-being can reinforce engagement in HIV care, quality of life and individual health outcomes Findings emphasize clinical and non- clinical importance of promoting early ART uptake and adherence

Page 9 Acknowledgements All study participants who provide their time and expertise Co-investigators and the research team at the BC-CfE Carmen Rock, Tricia Collingham, Deborah Graham, Peter Vann, Jennifer Matthews and Steve Kain for research and administrative assistance Study support from the US National Institutes of Health (R01DA021525) Canadian Institutes of Health Research, National Institutes of Health and the Michael Smith Foundation for Health Research, for additional research and investigator support