Methamphetamine use drives decreases in viral suppression for people living with HIV released from a large municipal jail: Results of the LINK LA clinical trial

Drug Alcohol Depend. 2019 Sep 1;202:178-184. doi: 10.1016/j.drugalcdep.2019.05.007. Epub 2019 Jul 16.

Abstract

Background: People living with HIV (PLWH) often experience decreases in HIV viral suppression (VS) after release from jail. The Linking Inmates to Care in LA (LINK LA) peer navigation intervention helped maintain VS 12 months after release from jail compared to standard of care. In this study, we analyzed correlates of substance use and tested whether substance use was an independent correlate of decreased VS in LINK LA participants.

Methods: We analyzed LINK LA data collected at baseline, 3, and 12 months. We defined high-risk drug use as any reported methamphetamine, cocaine, or opioid use in the 30 days prior to a study visit (or jail entry at baseline). We used generalized linear mixed models to test associations of sociodemographic variables with type of substance used, and we tested correlates of VS while controlling for time, the intervention, and their interaction.

Results: At baseline (n = 356), 71% of participants reported high-risk drug use: 58%, methamphetamine; 17%, cocaine; 7%, heroin; and 4%, prescription opioids. Non-Hispanic Whites and those younger than 35 were most likely to use methamphetamine; Blacks were most likely to use cocaine; people who inject drugs were most likely to use opioids. Participants who used high-risk drugs had 53% lower adjusted odds than non-users of maintaining VS (AOR 0.47, 95% CI 0.31-0.70, p < 0.001).

Conclusion: High-risk drug use, dominated by methamphetamine use, independently correlated with decreased VS among recently incarcerated PLWH. Improving HIV care continuum outcomes among populations leaving jail requires attention to efforts to address high-risk drug use.

Keywords: HIV viral suppression; Jail; Methamphetamine; Stimulant; Substance use.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesics, Opioid
  • Anti-HIV Agents / therapeutic use
  • Cocaine
  • Continuity of Patient Care / statistics & numerical data*
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / psychology*
  • Humans
  • Linear Models
  • Los Angeles
  • Male
  • Methamphetamine
  • Middle Aged
  • Patient Acceptance of Health Care / psychology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Prisoners / psychology
  • Prisoners / statistics & numerical data*
  • Prisons
  • Substance-Related Disorders / psychology*
  • Substance-Related Disorders / virology

Substances

  • Analgesics, Opioid
  • Anti-HIV Agents
  • Methamphetamine
  • Cocaine