August 4, 2008

Experimental Program Tries to Get Medical Care to HIV-Positive Crack-Cocaine Users

FORT LAUDERDALE, Fla. _ Some South Florida researchers are confident they have found a more reliable way to bring medical care to HIV-positive crack cocaine users, hard-to-reach patients who may spread the virus through risky behavior.

At the International AIDS Conference in Mexico City, a University of Miami team on Monday presented preliminary results of an experimental program to link HIV-positive crack-cocaine with health care. The study, to be completed in 2010, is being done with researchers at Emory University in Atlanta and funded by a $2 million grant from the National Institutes of Health.

The Miami team, led by Lisa Metsch and Dr. Allan Rodriguez, decided to study crack-cocaine users after hearing anecdotes from hospitals about how frequently users came in with infections.

"We were told over and over by the HIV clinicians that about a third of the people who are going into the hospital are involved in heavy drug use, particularly crack cocaine," Metsch said.

Crack-cocaine use often leads to HIV infection because of the risks _ including prostitution _ users will take to get more of the highly addictive drug and cuts that result from using a crack pipe, said Tom Liberti, chief of HIV/AIDS at the Florida Department of Health.

Among the study's preliminary findings: 25 percent of participants reported sexual behavior more likely to lead to HIV transmission and 17 percent reported never seeing an HIV-care provider. Seventy-six percent were not receiving medications to treat HIV.

The Miami team has approached HIV-positive crack-cocaine users in Jackson Memorial Hospital's emergency room since 2005, randomly dividing them into two groups: one that receives standard care, and another that goes through an eight-week series of classes designed to educate them about HIV and the health care system.

The standard approach _ telling a patient when and where to show up for an appointment _ leaves behind patients who are unfamiliar with the complex health system, who need transportation, or who lack the confidence to speak up when they are ignored by nurses or doctors, said Virginia Locascio, who runs the classes that are part of the experiment.

"Many of them don't know how to advocate for themselves, and they give up," Locascio said.

The doctors said although the needs and problems of HIV-infected drug users are dire, they have largely been "forgotten" by health care providers.

"Unless they get extra individual intervention, they don't make it," Rodriguez said.

Over the eight weeks, patients in the experiment take classes in how to use the health system, share stories of finding out they were HIV-positive and hand out condoms in their communities. Locascio accompanies them to doctors' appointments, and the team tracks down patients who don't show up for the classes or doctors' appointments. Finally, the experiment attempts to link patients to drug treatment.

Researchers said they will not be ready to release final results until the study is complete.


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