commentary: on-site treatment for HIV and HCV improves access but raises concerns about quality of care. Methadone Maintenance programs and other facilities where IVDUs may be involved can offer HIV care but the doctors oftentimes are not well trained to prescribe good care. Proper training can perhaps address this issue.
 
WESTPORT, CT (Reuters Health) - Easy access to treatment services can have a significant impact on compliance with antiretroviral therapy (ART) by HIV-infected women who use injection drugs, according to researchers in the US.
 
The new findings suggest that "equitable access and use of ART can be achieved regardless of HIV risk group category," Dr. Anne M. Rompalo, of The Johns Hopkins University School of Medicine, Baltimore, Maryland, and a multicenter team say in the September 1st issue of the Journal of Acquired Immune Deficiency Syndromes.
 
The investigators looked for factors associated with ART compliance in 579 HIV-infected women living in Detroit, Providence, Baltimore or the Bronx. Two of the four sites "offered on-site HIV care and treatment to all enrolled women," while the remaining sites "referred all participants for HIV care and treatment elsewhere," the team explains. None of the women had an AIDS diagnosis.
 
Women with CD4 cell counts lower than 500, those who were 38 or older and those who were not African-American were more likely than others to report having used ART, with or without Pneumocystis carinii (PCP) prophylaxis, in the past 6 months. Women who reported injection drug use were less likely than others to report having used ART or PCP prophylaxis, regardless of CD4 cell count, age or follow-up site.
 
But at centers providing on-site treatment, current injection drug users were as likely to report ART use as women with former or no drug use. In fact, "women followed at study sites that offered on-site HIV treatment reported more ART and PCP prophylaxis in the preceding 6 months compared with women attending referral study sites, regardless of CD4 cell count category, age, or risk cohort," the investigators say.
 
Although further study is needed, they conclude, the data suggest that providing on-site access to treatment services may be one way to improve ART compliance among HIV-infected female injection drug users.
 
J Gen Intern Med 2001;16:583-589.