Improvements in HIV treatment outcomes among indigenous and non-indigenous people who use illicit drugs in a Canadian setting

TLDR: Investigation of longitudinal changes in three HIV treatment indicators for IPLWH who use illicit drugs during a community‐wide treatment‐as‐prevention (TasP) initiative in British Columbia, Canada finds no significant differences between indigenous and non‐indigenous participants.

Abstract: Introduction : In many settings worldwide, members of indigenous groups experience a disproportionate burden of HIV. In Canada, there is an urgent need to improve HIV treatment outcomes for indigenous people living with HIV (IPLWH), to not only reduce HIV/AIDS-associated morbidity and mortality but also curb elevated rates of viral transmission. Thus, by comparing indigenous and non-indigenous participants in an ongoing longitudinal cohort of HIV-positive people who use illicit drugs, we sought to investigate longitudinal changes in three HIV treatment indicators for IPLWH who use illicit drugs during a community-wide treatment-as-prevention (TasP) initiative in British Columbia, Canada. Methods : We used data from the ACCESS study, an ongoing observational prospective cohort of HIV-positive illicit drug users recruited from community settings in Vancouver, British Columbia. Cohort data are linked to comprehensive retrospective and prospective clinical records in a setting of no-cost HIV/AIDS treatment and care. We used multivariable generalized estimating equations (GEE) to evaluate longitudinal changes in the proportion of participants with exposure to antiretroviral therapy (ART) in the previous 180 days, optimal adherence to ART (i.e. ≥95% vs. 0.1). Conclusions : In this large and long-term study involving community-recruited HIV-positive illicit drug users, we observed a substantial and increasing proportion of indigenous participants reach several important thresholds in HIV care at rates indistinguishable from non-indigenous participants. The current findings highlight the important role of TasP on vulnerable populations in this setting and contribute to the evidence base supporting the immediate scale-up of ART to address HIV/AIDS-associated morbidity, mortality and viral transmission. Keywords: HIV; AIDS; indigenous; highly active antiretroviral therapy; HAART; plasma HIV-1 RNA viral load; treatment-as-prevention. (Published: 18 April 2016) Citation: Milloy M-J et al. Journal of the International AIDS Society 2016, 19 :20617 http://www.jiasociety.org/index.php/jias/article/view/20617 | http://dx.doi.org/10.7448/IAS.19.1.20617