OUTPATIENT MEDICAL-CARE IN EDINBURGH FOR IDU-RELATED HIV

Using combined medical and drug clinics, by the end of 1990 we had ini tiated contact with 511 HIV positive individuals, 75% injection drug u se (IDU) related. We have previously reported a significant reduction in the number of missed appointments from 1985-89 following the introd uction of methadone and an all day clinic, but between 1989 and 1990 t he appointment default rate rose from 17 to 25%. A significant percent age increase in missed appointments was, however, only seen in those n ot attending the all day clinic (chi2(3) = 121.3, p < 0.001). An analy sis of the patients missing appointments during 1989-90 revealed that 36-45% of patients attending each year missed only 1 or 2 appointments , that the majority of missed appointments each year were accounted fo r by less than 20% of the patients, around 60% of these patients misse d appointments in both years and that only 2% of patients attending bo th years consistently miss 3 or more appointments per year. Laboratory monitoring of HIV, that is at least one sampling episode in a year, w as achieved, however, in 92-95% of the patients attending each year. T he annual number of patients lost to follow-up varied between 7 and 11 % per year, but did not change significantly over time, whilst the cum ulative number of HIV infected individuals lost to follow-up after 5 y ears was only 14%. Between 1986 and 1990 self-reported reduction in ID U was more likely in HIV positive than negative individuals; the numbe r of HIV positive individuals who reported injecting for more than 50% of the year fell from 40 to 5% (chi2(4) = 15.23, p < 0.01) whilst the number who reported at least one injection per year fell from 51 to 2 3% (chi2(4) = 62.06, p < 0.001). By comparison amongst non-HIV-infecte d patients the percentage who reported opiate use for more than 50% of the visits during a year rose from 54% in 1986 to a peak of 70% in 19 89 (chi2(4) =10.22, p < 0.05) and those who reported opiate use at kas t once during the year rose from 57% in 1986 to a peak of 75% in 1989 (chi2(4) = 14.3, p = 0.006). Combined medical and drug clinics from 19 86 to 1990 together with a multi-disciplinary team approach to medical care was successful in delivering health care to HIV-infected injecti on drug users. We have initiated and maintained contact with HIV infec ted drug users, undertaken laboratory monitoring of HIV in 95% of pati ents and noted a decrease in self-reported high risk injection drug us e. Whilst such a system is relatively inefficient from the health serv ice's point of view, it may be necessary in order to maintain contact with the most difficult drug users.