Abstract

BackgroundPeople who smoke crack cocaine and people who inject drugs are at-risk for criminal justice involvement as well as HIV and HCV infection. Compared to criminal justice involvement, substance use treatment (SUT) can be cost-effective in reducing drug use and its associated health and social costs. We conducted a cross-sectional study of people who smoke crack cocaine and people who inject drugs to examine the association between incarceration, community supervision and substance use treatment with HIV/HCV testing, components of the HIV treatment cascade, social and physical vulnerability and risk behavior.MethodsTargeted sampling methods were used to recruit people who smoke crack cocaine and people who inject drugs (N = 2072) in Oakland, California from 2011 to 2013. Poisson regression models were used to estimate adjusted prevalence ratios between study exposures and outcomes.ResultsThe overall HIV prevalence was 3.3% (95% CI 2.6–4.1). People previously experiencing incarceration were 21% (p < 0.001) and 32% (p = 0.001), respectively, more likely to report HIV and HCV testing; and were not more likely to report receiving HIV care or initiating ART. People previously experiencing community supervision were 17% (p = 0.001) and 15% (p = 0.009), respectively, more likely to report HIV and HCV testing; and were not more likely to report receiving HIV care or initiating ART. People with a history of SUT were 15% (p < 0.001) and 23% (p < 0.001), respectively, more likely to report receiving HIV and HCV testing, 67% (p = 0.016) more likely to report HIV care, and 92% (p = 0.012) more likely to report HIV treatment initiation. People previously experiencing incarceration or community supervision were also more likely to report homelessness, trouble meeting basic needs and risk behavior.ConclusionsPeople with a history of substance use treatment reported higher levels of HCV and HIV testing and greater access to HIV care and treatment among HIV-positive individuals. People with a history of incarceration or community supervision reported higher levels of HCV and HIV testing, but not greater access to HIV care or treatment among HIV-positive individuals., Substance use treatment programs that are integrated with other services for HIV and HCV will be critical to simultaneously address the underlying reasons drug-involved people engage in drug-related offenses and improve access to essential medical services.

Highlights

  • People who smoke crack cocaine and people who inject drugs are at-risk for criminal justice involvement as well as HIV and hepatitis C virus (HCV) infection

  • SUT has been shown to help people lower their risk of HIV acquisition and transmission, improve their access and adherence to HIV treatment and reduce their viral load [30,31,32,33]. In this cross-sectional study of People who smoke crack cocaine (PWSC) and people who inject drugs (PWID), we examine the association of a history of incarceration, community supervision and substance use treatment with access to HIV/HCV testing, components of the HIV treatment cascade, social and physical vulnerability and risk behavior

  • Alameda County was the first county in the United States to declare a state of emergency in 1998 due to a disproportionally high HIV prevalence among the African American population, an emergency that continues to this day [34]

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Summary

Introduction

People who smoke crack cocaine and people who inject drugs are at-risk for criminal justice involvement as well as HIV and HCV infection. For HCV, the advent of direct acting antiretroviral (DAA) medications, with a relatively short course of treatment and minimal side effects, has led to cure rates of 90%, and the possibility of virtually eliminating HCV transmission. Benefitting from these therapies, requires participation in a series of sequential steps, often referred to as the HIV or HCV treatment cascade [13, 14]. These include diagnosis of HIV/HCV, linkage to care, clinical evaluation, treatment initiation, retention in care, and treatment adherence, with the ultimate goal of making viral load undetectable [13,14,15]

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