Factors Associated with Failure to Receive Outpatient Treatment among HIV Inpatients Who Use Crack Cocaine

Diagnosis of HIV infection late in the course of the disease leads to ongoing HIV transmission and has been associated with cocaine use. To help elucidate why patients do not present to outpatient HIV care, researchers in Atlanta and Miami studied baseline interview data collected between 2006 and 2009 as part of a behavioral intervention study involving 355 HIV-infected medical inpatients who used crack cocaine.

• Fifty-four percent had CD4 cell counts of <200 cells per µl.

• Twenty-one percent of subjects had never received outpatient care for HIV infection.

• Factors associated with never having received outpatient HIV care included annual income of $5,000 or less (odds ratio [OR], 8.17), never having received drug treatment (OR, 4.13), and not being helped into care by a health-care provider, social worker, or family member at the time of HIV diagnosis (OR, 2.83).

Comments:

This study does not address why poorer HIV-infected inpatients are less likely to engage in outpatient care or the role of other factors such as depression, alcohol use, homelessness, insurance status, or lack of social support. It does highlight several potential “reachable” moments to engage such patients in outpatient treatment, namely, at the time of HIV diagnosis, during substance abuse treatment, and/or during inpatient hospitalization.

Alexander Y. Walley, MD, MSc

Reference:

Bell C, Metsch LR, Vogenthaler N, et al. Never in care: characteristics of HIV-infected crack cocaine users in 2 US cities who have never been to outpatient HIV care. J Acquir Immune Defic Syndr. February 18, 2010 [Epub ahead of print].