Optimizing Care for HIV-Infected People Who Use Drugs: Evidence-Based Approaches to Overcoming Healthcare Disparities

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 dia...

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Bibliographic Details
Published in:Clinical infectious diseases 2013-11, Vol.57 (9), p.1309-1317
Main Authors: Meyer, Jaimie P., Althoff, Amy L., Altice, Frederick L.
Format: Article
Language:English
Subjects:
AIDS
Antiretrovirals
Art therapy
Arts
Biological and medical sciences
Disease management
Drug abuse
Drug dependence
Evidence-based medicine
Health care industry
Health outcomes
Health Services Administration
Healthcare Disparities
HIV
HIV Infections - diagnosis
HIV Infections - drug therapy
HIV/AIDS
Human immunodeficiency virus
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Inequality
Infectious diseases
Invited
Medical diagnosis
Medical sciences
Opioid analgesics
Patient care
Substance-Related Disorders - complications
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary: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.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/cit427