Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa
Abstract Background 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...
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | Addiction Science & Clinical Practice |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13722-017-0077-x |
| _version_ | 1828277645974962176 |
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| author | Wendee M. Wechsberg Charles van der Horst Jacqueline Ndirangu Irene A. Doherty Tracy Kline Felicia A. Browne Jennifer M. Belus Robin Nance William A. Zule |
| author_facet | Wendee M. Wechsberg Charles van der Horst Jacqueline Ndirangu Irene A. Doherty Tracy Kline Felicia A. Browne Jennifer M. Belus Robin Nance William A. Zule |
| author_sort | Wendee M. Wechsberg |
| collection | DOAJ |
| description | Abstract Background 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). Methods 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. Results 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). Conclusions 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. |
| first_indexed | 2024-04-13T07:17:45Z |
| format | Article |
| id | doaj.art-33516fa0c0f9485196fb6f643d12f58e |
| institution | Directory Open Access Journal |
| issn | 1940-0640 |
| language | English |
| last_indexed | 2024-04-13T07:17:45Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
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| series | Addiction Science & Clinical Practice |
| spelling | doaj.art-33516fa0c0f9485196fb6f643d12f58e2022-12-22T02:56:42ZengBMCAddiction Science & Clinical Practice1940-06402017-04-0112111110.1186/s13722-017-0077-xSeek, test, treat: substance-using women in the HIV treatment cascade in South AfricaWendee M. Wechsberg0Charles van der Horst1Jacqueline Ndirangu2Irene A. Doherty3Tracy Kline4Felicia A. Browne5Jennifer M. Belus6Robin Nance7William A. Zule8Substance Use, Gender and Applied Research, RTI InternationalSchool of Medicine, University of North CarolinaSubstance Use, Gender and Applied Research, RTI InternationalUCB BiosciencesStatistics and Epidemiology, RTI InternationalSubstance Use, Gender and Applied Research, RTI InternationalPsychology Department, University of North CarolinaBiostatistics, School of Public Health, University of WashingtonSubstance Use, Gender and Applied Research, RTI InternationalAbstract Background 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). Methods 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. Results 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). Conclusions 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.http://link.springer.com/article/10.1186/s13722-017-0077-xSexually-active womenAlcohol and other drug useTreatment cascade |
| spellingShingle | Wendee M. Wechsberg Charles van der Horst Jacqueline Ndirangu Irene A. Doherty Tracy Kline Felicia A. Browne Jennifer M. Belus Robin Nance William A. Zule Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa Addiction Science & Clinical Practice Sexually-active women Alcohol and other drug use Treatment cascade |
| title | Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa |
| title_full | Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa |
| title_fullStr | Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa |
| title_full_unstemmed | Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa |
| title_short | Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa |
| title_sort | seek test treat substance using women in the hiv treatment cascade in south africa |
| topic | Sexually-active women Alcohol and other drug use Treatment cascade |
| url | http://link.springer.com/article/10.1186/s13722-017-0077-x |
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