Abstract
IntroductionUniversal provision of effective antiretroviral medication has been essential to reduce mortality, increase longevity, and reduce onward transmission of HIV. This study aims to illuminate persistent threats to the health and longevity of under-served PLWH in British Columbia (BC), Canada.MethodsBetween 2007 and 2010, 1000 PLWH across BC were enrolled in the Longitudinal Investigation into Supportive and Ancillary health services (LISA) study and completed a cross-sectional survey on their HIV-care experiences and healthcare engagement. The sample generally reflects an under-served population of PLWH. A linkage to the provincial Vital Statistics registry is used in this analysis in order to examine overall mortality and cause-specific mortality trends; probability of death was modeled using logistic regression for participants with ongoing clinical monitoring (n = 910).ResultsBy June 2017, 208 (20.8%) participants had died. The majority of deaths 57 (27.4%) were attributed to drug-related complications or overdoses, 39 (18.8%) were attributed to HIV-related complications, and 36 (17.3%) to non-AIDS-defining malignancies. We observed elevated odds of death among PLWH who smoked tobacco (aOR: 2.11, 95% CI: 1.38, 3.23), were older (aOR: 1.06 per one-year increase, 95% CI: 1.04, 1.08), indicated heavy alcohol consumption (aOR: 1.57, 95% CI: 1.11, 2.22), and reported unstable housing (aOR: 1.96, 95% CI: 1.37, 2.80); while higher CD4 cell count was protective (aOR: 0.87 per 100-unit increase, 95% CI: 0.79, 0.94) as was male gender), though non-significant (aOR: 0.73, 95% CI: 0.49, 1.07).ConclusionsOverdose is - the leading cause of mortality among a cohort of under-served PLWH in BC, Canada. Public health efforts to end the HIV epidemic and support the health and well-being of PLWH are being thwarted by persistent health inequities and the enormous and persistent risks facing people who use drugs. Integrated low-barrier primary care is essential for supporting under-served PLWH, and safe drug supply is needed to support PLWH who use drugs.
Highlights
Universal provision of effective antiretroviral medication has been essential to reduce mortality, increase longevity, and reduce onward transmission of Human Immunodeficiency Virus (HIV)
In British Columbia (BC), Canada, evidence-based public health strategies have focused on expanding access to HIV care and treatment for all people living with HIV (PLWH), including universal access to publicly-funded modern antiretroviral therapy (ART) [2]
Between July 2007 and January 2010, the estimated 9514 PLWH enrolled in the Drug Treatment Program (DTP) registry were eligible to participate in the LISA survey and were invited through study information letters distributed by physicians providing HIV care, posters at pharmacies where patients refilled ART prescriptions, notices posted at HIV/Acquired Immunodeficiency Syndrome (AIDS) clinics and service organizations across the province, as well as through word-of-mouth
Summary
Universal provision of effective antiretroviral medication has been essential to reduce mortality, increase longevity, and reduce onward transmission of HIV. In British Columbia (BC), Canada, evidence-based public health strategies have focused on expanding access to HIV care and treatment for all people living with HIV (PLWH), including universal access to publicly-funded modern antiretroviral therapy (ART) [2]. These strategic efforts, coupled with therapeutic advances in HIV treatment and developments in supportive HIV-care, have contributed to a dramatic reduction in mortality among PLWH in the province [3,4,5]. Adrian Dix, along with Dr Julio Montaner, Director of the BC Centre for Excellence in HIV/AIDS (BC-CfE), announced the province has achieved record low numbers of new HIV cases, [9] – a 73% reduction since 1996, indicating a significant shift in the epidemic [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
