Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa.

Journal: Addiction science & clinical practice

Volume: 12

Issue: 1

Year of Publication: 2018

Affiliated Institutions:  Substance Use, Gender and Applied Research, RTI International, East Cornwallis Road, Research Triangle Park, NC, -, USA. wmw@rti.org. School of Medicine, University of North Carolina, Chapel Hill, NC, USA. Substance Use, Gender and Applied Research, RTI International, Pretoria, South Africa. UCB Biosciences, Raleigh, NC, USA. Statistics and Epidemiology, RTI International, East Cornwallis Road, Research Triangle Park, NC, -, USA. Substance Use, Gender and Applied Research, RTI International, East Cornwallis Road, Research Triangle Park, NC, -, USA. Psychology Department, University of North Carolina, Chapel Hill, NC, USA. Biostatistics, School of Public Health, University of Washington, NE Campus Parkway, Seattle, WA, USA.

Abstract summary 

Women in South Africa who use alcohol and other drugs face multiple barriers to HIV care. These barriers make it difficult for women to progress through each step in the HIV treatment cascade from diagnosis to treatment initiation and adherence. This paper examines correlates of HIV status, newly diagnosed HIV status, and use of antiretroviral therapy (ART).Outreach workers recruited sexually active Black African women who used substances in Pretoria as part of a U.S. National Institutes of Health-funded geographically clustered randomized trial examining the effect of an intervention to reduce alcohol and drug use as well as sexual risk behaviors. To address the question of interest in the current investigation, cross-sectional baseline data were used. At study enrollment, all participants (N = 641) completed an interview, and underwent rapid HIV testing and biological drug screening. Those who tested positive for HIV and were eligible for ART were asked about their barriers to initiating or adhering to ART. Bivariate and multivariable logistic regression analyses were conducted to determine correlates of HIV status, newly diagnosed HIV, and ART use.At enrollment, 55% of participants tested positive for HIV, and 36% of these women were newly diagnosed. In multivariable analyses of the entire sample, women who had completed 10th grade were less likely to be living with HIV (OR 0.69; CI 0.48, 0.99) and those from the inner city were more likely to be living with HIV (OR 1.83; CI 1.26, 2.67). Among HIV-positive participants, women were less likely to be newly diagnosed if they had ever been in substance abuse treatment (OR 0.15; CI 0.03, 0.69) or used a condom at last sex (OR 0.58; CI 0.34, 0.98) and more likely to be newly diagnosed if they were physically assaulted in the past year (OR 1.97; CI 1.01, 3.84). Among women eligible for ART, fewer were likely to be on treatment (by self-report) if they had a positive urine test for opiates or cocaine (OR 0.27; CI 0.09, 0.80).These results, although cross-sectional, provide some guidance for provincial authorities to address barriers to HIV care for sexually active, substance-using vulnerable women in Pretoria. Targeting the inner city with prevention campaigns, expanding and improving substance abuse treatment programs, linking clients with simultaneous HIV testing and treatment, and targeting women who have experienced sexual assault and violence may help the government achieve the UNAIDS 90-90-90 treatment target. Clinical Trials.gov NCT01497405 registered on December 1, 2011.

Authors & Co-authors:  Wechsberg Wendee M WM van der Horst Charles C Ndirangu Jacqueline J Doherty Irene A IA Kline Tracy T Browne Felicia A FA Belus Jennifer M JM Nance Robin R Zule William A WA

Study Outcome 

Source Link: Visit source

Statistics
Citations :  UN Women. Facts and figures: HIV and AIDS. 6/2016 edn. New York, NY: UN Women; 2016.
Authors :  9
Identifiers
Doi : 12
SSN : 1940-0640
Study Population
Women
Mesh Terms
Adolescent
Other Terms
Alcohol and other drug use;Sexually-active women;Treatment cascade
Study Design
Randomized Control Trial,Cross Sectional Study
Study Approach
Country of Study
South Africa
Publication Country
England