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Residential Eviction and Risk of Detectable Plasma HIV-1 RNA Viral Load Among HIV-Positive People Who Use Drugs

Abstract

We examined the relationship between residential eviction and exhibiting detectable plasma HIV-1 RNA viral load (VL) among a prospective cohort of antiretroviral therapy (ART)-exposed HIV-seropositive people who use illicit drugs (PWUD) in Vancouver, Canada. We used multivariable generalized estimating equations to estimate the effect of residential eviction on detectable VL and examine ART adherence as a mediating variable. Between June 2007 and May 2014, 705 ART-exposed participants were included in the study, among whom 500 (70.9 %) experienced at least one period of detectable VL. In a time-updated multivariable model, eviction independently increased the odds of detectable VL among those who were homeless [adjusted odds ratio (AOR) = 2.25; 95 % confidence interval (CI) 1.18–4.29] as well as not homeless (AOR = 1.76; 95 % CI 1.17–2.63) post eviction. The results of mediation analyses suggest that this association was mediated by incomplete ART adherence. These findings suggest the need for further development and evaluation of interventions to prevent evictions and promote ART adherence among PWUD facing eviction.

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Acknowledgments

The authors thank the study participants for their contribution to the research, as well as current and past researchers and staff. We would specifically like to thank Cody Callon, Deborah Graham, Peter Vann, Steve Kain, Kristie Starr, Tricia Collingham, and Carmen Rock for their research and administrative assistance. The study was supported by the United States National Institutes of Health (R01DA021525 and R01DA033147). This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine, which supports Dr. Evan Wood. Mary Clare Kennedy is supported by Mitacs through the Mitacs Accelerate Program. M-J Milloy is supported in part by the United States National Institutes of Health (R01DA021525). Ryan McNeil is supported by the Michael Smith Foundation for Health Research. Dr. Julio Montaner is supported with grants paid to his institution by the British Columbia Ministry of Health and the US National Institutes of Health (NIDA-R01DA036307). He has also received limited unrestricted funding, paid to his institution, from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare.

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Correspondence to M.-J. Milloy.

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Kennedy, M.C., Kerr, T., McNeil, R. et al. Residential Eviction and Risk of Detectable Plasma HIV-1 RNA Viral Load Among HIV-Positive People Who Use Drugs. AIDS Behav 21, 678–687 (2017). https://doi.org/10.1007/s10461-016-1315-z

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Keywords

  • Illicit drug use
  • Housing eviction
  • Detectable plasma viral load
  • HIV/AIDS
  • Canada