Public Health Service Amsterdam, Department of Research, Cluster Infectious Diseases, Amsterdam, The Netherlands.
Int J Drug Policy. 2011 May;22(3):210-8. doi: 10.1016/j.drugpo.2011.02.004. Epub 2011 Mar 9.
Opioid substitution treatment seems to improve adherence to highly active antiretroviral therapy (HAART) in drug users (DU). DU in Amsterdam receive methadone within a harm reduction programme. We hypothesized that not only receiving methadone, but joining this complete comprehensive programme would improve HAART adherence.
Included were 102 HIV-positive DU attending the Amsterdam Cohort Study (ACS), reporting HAART use at multiple visits between 1999 and 2009. Non-adherence was defined as taking less than 95% of medication in the past 6 months (self-reported). Harm reduction intensity (HR) was measured by combining injecting drug use, methadone dosage and needle exchange, in different levels of participation, ranging from no/incomplete HR, complete HR to low or no dependence on HR. We studied the association between non-adherence and harm reduction intensities with logistic regression models adjusted for repeated measurements.
Non-adherence was reported in 11.9% of ACS visits. Non-injecting DU with low dependence on HR were less adherent than DU with complete HR (aOR 1.78; CI 95% 1.00-3.16), although there was no overall effect of HR. No difference was demonstrated in adherence between DU with complete HR and incomplete HR. Unsupervised housing (no access to structural support at home) (aOR 2.58; CI 95% 1.40-4.73) and having a steady partner (aOR 0.48; CI 95% 0.24-0.96) were significantly associated with respectively more and less non-adherence.
In Amsterdam, still-injecting DU who are exposed to systematic and integrated care, although not practising complete harm reduction, can be just as adherent to HAART as DU who make use of complete harm reduction and non-injecting DU with no dependence on harm reduction. These findings suggest the importance of a systematic and comprehensive support system including supervised housing and social and medical support to increase HAART adherence rates amongst all HIV-infected DU. When such programmes are introduced in settings where injecting drug use is highly prevalent, access to HAART for drug users in these settings can and should be increased.
阿片类物质替代疗法似乎可以提高吸毒者（DU）对高效抗逆转录病毒治疗（HAART）的依从性。阿姆斯特丹的 DU 患者在减少伤害项目中接受美沙酮治疗。我们假设，不仅接受美沙酮，而且加入这个全面综合的项目也会提高 HAART 的依从性。
纳入了 102 名接受阿姆斯特丹队列研究（ACS）的 HIV 阳性 DU，他们在 1999 年至 2009 年期间的多次就诊中报告了 HAART 的使用情况。依从性定义为过去 6 个月内服用的药物少于 95%（自我报告）。伤害减少强度（HR）通过结合注射吸毒、美沙酮剂量和针具交换来测量，在不同的参与水平上，从无/不完整的 HR 到完全 HR 到对 HR 的低或无依赖。我们使用逻辑回归模型研究了非依从性与伤害减少强度之间的关联，该模型调整了重复测量。
在 ACS 就诊中，11.9%的就诊报告了非依从性。非注射 DU 患者对 HR 的依赖程度较低，与完全 HR 的 DU 患者相比，他们的依从性较差（aOR 1.78；95%CI 1.00-3.16），尽管 HR 没有总体影响。完全 HR 和不完全 HR 的 DU 患者之间的依从性没有差异。无监督住房（无家庭结构支持）（aOR 2.58；95%CI 1.40-4.73）和有稳定伴侣（aOR 0.48；95%CI 0.24-0.96）与非依从性分别显著相关，更多和更少的非依从性。
在阿姆斯特丹，虽然仍在注射的 DU 患者接触到系统和综合的护理，但即使他们没有完全实施伤害减少，他们对 HAART 的依从性也可以与使用完全伤害减少的 DU 患者和对伤害减少没有依赖的非注射 DU 患者一样高。这些发现表明，建立一个包括监督住房和社会医疗支持在内的系统和全面的支持系统的重要性，以提高所有感染 HIV 的 DU 患者的 HAART 依从率。当在注射毒品使用非常普遍的环境中引入这些方案时，这些环境中吸毒者获得 HAART 的机会可以而且应该增加。
