BARRIERS TO USE OF FREE ANTIRETROVIRAL THERAPY IN INJECTION-DRUG USERS

Context.-In British Columbia, human immunodeficiency virus (HIV)-infec ted persons eligible for antiretroviral therapy may receive it free bu t the extent to which HIV-infected injection drug users access it is u nknown. Objective.-To identify patient and physician characteristics a ssociated with antiretroviral therapy utilization in HIV-infected inje ction drug users. Design.-Prospective cohort study with record linkage between survey data and data from a provincial HIV/AIDS (acquired imm unodeficiency syndrome) drug treatment program. Setting.-British Colum bia, where antiretroviral therapies are offered free to all persons wi th HIV infection with CD4 cell counts less than 0.50x10(9)/L (500/mu L ) and/or HIV-1 RNA levels higher than 5000 copies/mL. Subjects.-A tota l of 177 HIV-infected injection drug users eligible for antiretroviral therapy, recruited through the prospective cohort study since May 199 6. Main Outcome Measures.-Patient use of antiretroviral drugs through the provincial drug treatment program and physician experience treatin g HIV infection. Results.-After a median of 11 months after first elig ibility, only 71 (40%) of 177 patients had received any antiretroviral drugs, primarily double combinations (47/ 71 [66%]). Both patient and physician characteristics were associated with use of antiretroviral drugs. After adjusting for CD4 cell count and HIV-1 RNA level at eligi bility, odds of not receiving antiretrovirals were increased more than 2-fold for females (odds ratio [OR], 2.53; 95% confidence interval [C I], 1.08-5.93) and 3-fold for those not currently enrolled in drug or alcohol treatment programs (OR, 3.49; 95% CI, 1.45-8.40), Younger drug users were less likely to receive therapy (OR, 0.47/ 10-y increase; 9 5% CI, 0.28-0.80). Those with physicians having the least experience t reating persons with HIV infection were more than 5 times less likely to receive therapy (OR, 5.55; 95% CI, 2.49-12.37). Conclusions.-Despit e free antiretroviral therapy, many HIV-infected injection drug users are not receiving it. Public health efforts should target younger and female drug users, and physicians with less experience treating HIV in fection.