Access to antiviral medication for HIV and HCV infected drug users

Injection drug users (IDUs) acquire human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections through the sharing of needles and other injection equipment. Social and economic barriers to care, and provider concerns related to medication adherence, side effects, development and spread of resistant virus preclude infected IDUs from appropriate medical care. This dissertation begins with a summary of the state of drug users within the HIV and HCV epidemics and their barriers to antiviral care. The first manuscript examines the challenges of medical care providers when making treatment decisions for HIV-infected drug users. These data suggest that addressing the social barriers and competing health care needs among drug users is essential to diminishing disparities in access to care for this population.; Methadone maintenance treatment (MMT) is a gateway to medical care for infected drug user. The second manuscript establishes the burden of HCV infection in a Baltimore City MMT population, examines medical and socioeconomic correlates to HCV infection; and presents evidence that lack of insurance, current drug or alcohol use, and mental illness are obstacles for treatment for over three quarters of the HCV-infected MMT population. Underscored by data presented, there is a need to create or expand such Federal entitlement programs for the provision of HCV care in the United States. The dissertation concludes that substance abuse treatment, mental health care and the integration of social services are essential to HIV or HCV medical care for drug users. Future research directions include continued evaluation of the delivery of antiviral treatment within MMT programs; and the continued surveillance for HIV and HCV antiviral treatments effectiveness and safety, the development and spread of resistant viruses, and the rates of drug use relapse.