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Review
. 2013 Nov;57(9):1309-17.
doi: 10.1093/cid/cit427. Epub 2013 Jun 23.

Optimizing care for HIV-infected people who use drugs: evidence-based approaches to overcoming healthcare disparities

Jaimie P Meyer  1 , Amy L Althoff, Frederick L Altice
Affiliations
Review

Optimizing care for HIV-infected people who use drugs: evidence-based approaches to overcoming healthcare disparities

Jaimie P Meyer et al. Clin Infect Dis. 2013 Nov.

Abstract

Substance use disorders (SUDs) and human immunodeficiency virus (HIV) are pervasive epidemics that synergize, resulting in negative outcomes for HIV-infected people who use drugs (PWUDs). The expanding epidemiology of substance use demands a parallel evolution of the HIV specialist-beyond HIV to diagnosis and management of comorbid SUDs. The purpose of this paper is to describe healthcare disparities for HIV-infected PWUDs along each point of a continuum of care, and to suggest evidence-based strategies for overcoming these healthcare disparities. Despite extensive dedicated resources and availability of antiretroviral therapy (ART) in the United States, PWUDs continue to experience delayed HIV diagnosis, reduced entry into and retention in HIV care, delayed initiation of ART, and inferior HIV treatment outcomes. Overcoming these healthcare disparities requires integrated packages of clinical, pharmacological, behavioral, and social services, delivered in ways that are cost-effective and convenient and include, at a minimum, screening for and treatment of underlying SUDs.

Keywords: HIV; engagement in care; healthcare disparities; substance use disorders; treatment.

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Figures

Figure 1.
Figure 1.
Strategies to overcome healthcare disparities for human immunodeficiency virus (HIV)–infected people who use drugs at each step of continuum of HIV care: roadmap of findings. For further details on each of these evidence-based strategies, please refer to the main text. Abbreviations: ART, antiretroviral therapy; CJS, criminal justice system; DAART, directly administered antiretroviral therapy; HIV, human immunodeficiency virus; SBIRT, screening, brief intervention, and referral to treatment.
Figure 2.
Figure 2.
Screening, brief intervention, and referral to treatment (SBIRT) algorithm [72, 73].
See this image and copyright information in PMC

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