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. 2023 Jul 15;37(9):1431-1440.
doi: 10.1097/QAD.0000000000003570. Epub 2023 Apr 5.

Experiencing homelessness and progression through the HIV cascade of care among people who use drugs

Hudson Reddon  1   2 , Nadia Fairbairn  1   2 , Cameron Grant  1 , M-J Milloy  1   2
Affiliations

Experiencing homelessness and progression through the HIV cascade of care among people who use drugs

Hudson Reddon et al. AIDS. .

Abstract

Objective: To investigate the longitudinal association between periods of homelessness and progression through the HIV cascade of care among people who use drugs (PWUD) with universal access to no-cost HIV treatment and care.

Design: Prospective cohort study.

Methods: Data were analysed from the ACCESS study, including systematic HIV clinical monitoring and a confidential linkage to comprehensive antiretroviral therapy (ART) dispensation records. We used cumulative link mixed-effects models to estimate the longitudinal relationship between periods of homelessness and progression though the HIV cascade of care.

Results: Between 2005 and 2019, 947 people living with HIV were enrolled in the ACCESS study and 304 (32.1%) reported being homeless at baseline. Homelessness was negatively associated with overall progression through the HIV cascade of care [adjusted partial proportional odds ratio (APPO) = 0.56, 95% confidence interval (CI): 0.49-0.63]. Homelessness was significantly associated with lower odds of progressing to each subsequent stage of the HIV care cascade, with the exception of initial linkage to care.

Conclusions: Homelessness was associated with a 44% decrease in the odds of overall progression through the HIV cascade of care, and a 41-54% decrease in the odds of receiving ART, being adherent to ART and achieving viral load suppression. These findings support calls for the integration of services to address intersecting challenges of HIV, substance use and homelessness among marginalized populations such as PWUD.

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Conflict of interest statement

None declared. This study was supported by the US National Institutes of Health (U01-DA0251525) and this research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine. H. R. is supported by a CIHR fellowship award. N.F. is supported by a MSFHR/St. Paul’s Foundation Scholar Award and the Philip Owen Professorship in Addiction Medicine. M.-J. M. is supported in part by the United States National Institutes of Health (U01-DA021525), a New Investigator Award from CIHR and a Scholar Award from MSFHR. M.-J. M. is the Canopy Growth professor of cannabis science, a position established through unstructured gifts to the University of British Columbia from Canopy Growth, a licensed producer of cannabis, and the Ministry of Mental Health and Addictions of the Government of British Columbia. He has no financial relationships with the cannabis industry.

Figures

Figure 1.
Figure 1.
Adjusted cumulative linked mixed-effects model analysis of the association between homelessness and progression through the HIV cascade of care among 947 PWUD living with HIV. Notes: CI=confidence interval, ART=antiretroviral therapy, VL= plasma HIV-1 RNA viral load.
See this image and copyright information in PMC

Comment in

  • Housing is harm reduction.
    Friedman MR, Kay ES, Maclin BJ, Hawk ME. Friedman MR, et al. AIDS. 2023 Jul 15;37(9):1477-1479. doi: 10.1097/QAD.0000000000003615. AIDS. 2023. PMID: 37395253 Free PMC article. No abstract available.

References

    1. Samji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, et al., Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One, 2013. 8(12): p. e81355. - PMC - PubMed
    1. Teeraananchai S, Kerr SJ, Amin J, Ruxrungtham K, and Law MG, Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV Med, 2017. 18(4): p. 256–266. - PubMed
    1. Croxford S, Kitching A, Desai S, Kall M, Edelstein M, Skingsley A, et al., Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort. Lancet Public Health, 2017. 2(1): p. e35–e46. - PubMed
    1. Wood E, Hogg RS, Yip B, Harrigan PR, and Montaner JS, Why are baseline HIV RNA levels 100,000 copies/mL or greater associated with mortality after the initiation of antiretroviral therapy? J Acquir Immune Defic Syndr, 2005. 38(3): p. 289–95. - PubMed
    1. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al., Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med, 2011. 365(6): p. 493–505. - PMC - PubMed

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