Drug and Alcohol Dependence 64 (2001) 55–62 Access to medical care and service utilization among injection drug users with HIV/AIDS Amy R. Knowlton a, *, Donald R. Hoover b , Shang-en Chung a , David D. Celentano c , David Vlahov c,1 , Carl A. Latkin a a Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, 624 North Broadway, Baltimore, MD 21205, USA b Department of Statistics and Center for Health Care Policy and Aging Research, Rutgers Uniersity, Piscattaway, NJ 08901, USA c Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, 624 North Broadway, Baltimore, MD 21205, USA Received 12 June 2000; received in revised form 21 November 2000; accepted 21 November 2000 Abstract Access to care and optimal service utilization among 287 low income African American former and current drug injectors was examined. Results indicated suboptimal outpatient care, and no evidence of alternative use of hospital services. Participation in drug treatment and case management were associated with greater access to care and use of outpatient services, even after controlling for current drug use, gender, and insurance. AIDS and physical functioning limitation were associated with emergency room (ER) use and hospitalization. Participation in drug treatment and case management and an AIDS diagnosis were associated with optimal outpatient service use. Daily alcohol use was associated with ER as the usual facility for care. Integration of substance abuse treatment, case management, and medical services delivery may contribute to improved HIV care for this population. © 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: HIV/AIDS; Health service utilization; Case management; Drug treatment; Injection drug users www.elsevier.com/locate/drugalcdep 1. Introduction 1.1. Background Injection drug use accounts for more than one-third of AIDS cases in the US (Centers for Disease Control and Prevention, 1998). Research suggests that low in- come, racial minority injection drug users have lower access to medical care (Chitwood, et al., 1999). However, few studies have examined factors that enable access to care and HIV service use in this population. Much of the prior research has been conducted with populations recruited from medical and drug treatment clinics, mak- ing it difficult to adequately examine access to care. Recent studies suggest that injection drug users receive a disproportionately high amount of hospital resources compared to other HIV-positive groups (Fleishman et al., 1995), yet overall they receive inadequate HIV medical care (Shapiro, et al., 1999; Andersen, et al., 2000). The present study sought to identify factors that facilitate access to care and optimal service use among low income, minority injection drug users with HIV/ AIDS. 1.2. Health serices utilization among persons with HIV /AIDS In studies of persons with HIV/AIDS, injection drug has been found to be associated with more emergency room (ER) and inpatient service use, and less outpatient service use compared to non-injection drug users (Mor et al., 1992). Black race compared to non-black race has been found to be associated with less outpatient care and more inpatient and ER care, even after controlling for socioeconomic status, health status, substance use and other potential confounders (Fleishman et al., 1994). * Corresponding author. Tel.: +1-410-5025368; fax: +1-410- 5025385. E-mail address: aknowlto@jhsph.edu (A.R. Knowlton). 1 Present address: New York Academy of Medicine, New York City, USA. 0376-8716/01/$ - see front matter © 2001 Elsevier Science Ireland Ltd. All rights reserved. PII:S0376-8716(00)00228-3