Substance Use and its Impact on Care Outcomes among HIV-Infected Individuals in Manitoba
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BACKGROUND: The high prevalence of substance use among HIV-infected individuals creates numerous challenges to patient care. This study was undertaken in order to understand the impact of substance use on care outcomes for HIV-infected persons in Manitoba. METHODS: Clinical records of 564 HIV-infected individuals in care at the Health Sciences Centre in Winnipeg, Manitoba were reviewed. Clinical data was extracted from patient charts for substance users (illicit substance users, alcohol abusers, and chronic users of opioids or benzodiazepines) and non-users. RESULTS: Among HIV-infected individuals in Manitoba, 38% were substance users with overrepresentation by Aboriginals, females, young adults, and residents of Winnipeg's core areas. Opioids and benzodiazepines were the most commonly used substances with the majority of substance users having used multiple classes of substances in their lifetime. Substance users were more likely than non-users to have missed clinic appointments. Among substance users, missed appointments were more common among those who self-identified as Aboriginal, females, young adults, residents of Winnipeg's core areas, heterosexuals, and those who had abused alcohol or cocaine/crack. Substance use also affected the prescription of antiretroviral medications and was associated with liver damage. DISCUSSION: Substance use is common among HIV-infected individuals in Manitoba, with important health-related implications arising from the use and/or misuse of potentially harmful substances. The negative impact of substance use on engagement in care and health outcomes has important implications on clinical care which must be addressed by targeted patient recruitment, the use of harm reduction and patient-centred care.