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The opioid crisis is driving mortality among under-served people living with HIV in British Columbia, Canada
INTRODUCTION: Universal 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), Cana...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028792/ https://www.ncbi.nlm.nih.gov/pubmed/33832472 http://dx.doi.org/10.1186/s12889-021-10714-y |
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author | Salters, Kate A. Parent, Stephanie Nicholson, Valerie Wang, Lu Sereda, Paul Pakhomova, Tatiana E. Kibel, Mia Chau, William Closson, Kalysha Parashar, Surita Barrios, Rolando Montaner, Julio S. G. Hogg, Robert S. |
author_facet | Salters, Kate A. Parent, Stephanie Nicholson, Valerie Wang, Lu Sereda, Paul Pakhomova, Tatiana E. Kibel, Mia Chau, William Closson, Kalysha Parashar, Surita Barrios, Rolando Montaner, Julio S. G. Hogg, Robert S. |
author_sort | Salters, Kate A. |
collection | PubMed |
description | INTRODUCTION: Universal 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. METHODS: Between 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). RESULTS: By 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). CONCLUSIONS: Overdose 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. |
format | Online Article Text |
id | pubmed-8028792 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-80287922021-04-09 The opioid crisis is driving mortality among under-served people living with HIV in British Columbia, Canada Salters, Kate A. Parent, Stephanie Nicholson, Valerie Wang, Lu Sereda, Paul Pakhomova, Tatiana E. Kibel, Mia Chau, William Closson, Kalysha Parashar, Surita Barrios, Rolando Montaner, Julio S. G. Hogg, Robert S. BMC Public Health Research Article INTRODUCTION: Universal 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. METHODS: Between 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). RESULTS: By 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). CONCLUSIONS: Overdose 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. BioMed Central 2021-04-08 /pmc/articles/PMC8028792/ /pubmed/33832472 http://dx.doi.org/10.1186/s12889-021-10714-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Salters, Kate A. Parent, Stephanie Nicholson, Valerie Wang, Lu Sereda, Paul Pakhomova, Tatiana E. Kibel, Mia Chau, William Closson, Kalysha Parashar, Surita Barrios, Rolando Montaner, Julio S. G. Hogg, Robert S. The opioid crisis is driving mortality among under-served people living with HIV in British Columbia, Canada |
title | The opioid crisis is driving mortality among under-served people living with HIV in British Columbia, Canada |
title_full | The opioid crisis is driving mortality among under-served people living with HIV in British Columbia, Canada |
title_fullStr | The opioid crisis is driving mortality among under-served people living with HIV in British Columbia, Canada |
title_full_unstemmed | The opioid crisis is driving mortality among under-served people living with HIV in British Columbia, Canada |
title_short | The opioid crisis is driving mortality among under-served people living with HIV in British Columbia, Canada |
title_sort | opioid crisis is driving mortality among under-served people living with hiv in british columbia, canada |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028792/ https://www.ncbi.nlm.nih.gov/pubmed/33832472 http://dx.doi.org/10.1186/s12889-021-10714-y |
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