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Abstract
Infectious disease has a major impact on the health outcomes of underserved populations and is reported at significantly higher rates among these populations compared with the general population. Overcoming barriers and obstacles to health care access is key to addressing the disparity regarding the prevalence of infectious disease. Enhancing cultural competency and educating practitioners about underserved populations' basic health needs; optimizing health insurance for the underserved; increasing community resources; and improving access to comprehensive, continuous, compassionate, and coordinated health care are strategies for diminishing the burden of infectious disease in underserved populations.
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Affiliation(s)
- Samuel Neil Grief
- Department of Family Medicine, University of Illinois at Chicago, 1919 West Taylor Street, Chicago, IL 60612, USA.
| | - John Paul Miller
- Bakersfield Memorial Family Medicine Residency Program, Department of Family Medicine, University of California Irvine School of Medicine, 420 34th Street, Bakersfield, CA 93301, USA
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Feng MC, Feng JY, Chen YH, Chang PY, Lu PL. Prevalence and knowledge of sexual transmitted infections, drug abuse, and AIDS among male inmates in a Taiwan prison. Kaohsiung J Med Sci 2012; 28:660-6. [DOI: 10.1016/j.kjms.2012.04.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/05/2011] [Indexed: 10/28/2022] Open
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Uldall KK, Palmer NB, Whetten K, Mellins C. Adherence in people living with HIV/AIDS, mental illness, and chemical dependency: a review of the literature. AIDS Care 2010; 16 Suppl 1:S71-96. [PMID: 15736823 DOI: 10.1080/09540120412331315277] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Adherence to antiretroviral medications is central to reducing morbidity and mortality among people living with HIV/AIDS. Relatively few studies published to date address HIV adherence among special populations. The purpose of this article is to review the existing literature on HIV antiretroviral adherence, with an emphasis on studies among the triply diagnosed population of people living with HIV/AIDS, mental illness, and chemical dependency. In order to reflect the most current information available, data from conference proceedings, federally funded studies in progress, and the academic literature are presented for consideration.
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Affiliation(s)
- K K Uldall
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104, USA.
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Knowlton AR, Arnsten JH, Eldred LJ, Wilkinson JD, Shade SB, Bohnert AS, Yang C, Wissow LS, Purcell DW. Antiretroviral use among active injection-drug users: the role of patient-provider engagement and structural factors. AIDS Patient Care STDS 2010; 24:421-8. [PMID: 20578910 DOI: 10.1089/apc.2009.0240] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
HIV-seropositive, active injection-drug users (IDUs), compared with other HIV populations, continue to have low rates of highly active antiretroviral therapy (HAART) use, contributing to disparities in their HIV health outcomes. We sought to identify individual-level, interpersonal, and structural factors associated with HAART use among active IDUs to inform comprehensive, contextually tailored intervention to improve the HAART use of IDUs. Prospective data from three semiannual assessments were combined, and logistic general estimating equations were used to identify variables associated with taking HAART 6 months later. Participants were a community sample of HIV-seropositive, active IDUs enrolled in the INSPIRE study, a U.S. multisite (Baltimore, Miami, New York, San Francisco) prevention intervention. The analytic sample included 1,225 observations, and comprised 62% males, 75% active drug users, 75% non-Hispanic blacks, and 55% with a CD4 count <350; 48% reported HAART use. Adjusted analyses indicated that the later HAART use of IDUs was independently predicted by patient-provider engagement, stable housing, medical coverage, and more HIV primary care visits. Significant individual factors included not currently using drugs and a positive attitude about HAART benefits even if using illicit drugs. Those who reported patient-centered interactions with their HIV primary care provider had a 45% greater odds of later HAART use, and those with stable housing had twofold greater odds. These findings suggest that interventions to improve the HIV treatment of IDUs and to reduce their HIV health disparities should be comprehensive, promoting better patient-provider engagement, stable housing, HAART education with regard to illicit drug use, and integration of drug-abuse treatment with HIV primary care.
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Affiliation(s)
- Amy R. Knowlton
- Department of Health, Behavior and Society; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julia H. Arnsten
- Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Lois J. Eldred
- At the time of the study, was at the Special Projects of National Significance, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland. Now at the Johns Hopkins School of Medicine, Baltimore, Maryland
| | - James D. Wilkinson
- Departments of Pediatrics and Epidemiology and Public Health, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Starley B. Shade
- AIDS Research Institute, University of California, San Francisco, California
| | - Amy S. Bohnert
- At the time of the study was at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Now at Veterans Affairs, National Serious Mental Illness Treatment Research Evaluation Center, Ann Arbor, Michigan
| | - Cui Yang
- Department of Health, Behavior and Society; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence S. Wissow
- Department of Health, Behavior and Society; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David W. Purcell
- Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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