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Prevalence and Predictors of Substance Use Disorders Among HIV Care Enrollees in the United States

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Abstract

Prior efforts to estimate U.S. prevalence of substance use disorders (SUDs) in HIV care have been undermined by caveats common to single-site trials. The current work reports on a cohort of 10,652 HIV-positive adults linked to care at seven sites, with available patient data including geography, demography, and risk factor indices, and with substance-specific SUDs identified via self-report instruments with validated diagnostic thresholds. Generalized estimating equations also tested patient indices as SUD predictors. Findings were: (1) a 48 % SUD prevalence rate (between-site range of 21–71 %), with 20 % of the sample evidencing polysubstance use disorder; (2) substance-specific SUD rates of 31 % for marijuana, 19 % alcohol, 13 % methamphetamine, 11 % cocaine, and 4 % opiate; and (3) emergence of younger age and male gender as robust SUD predictors. Findings suggest high rates at which SUDs occur among patients at these urban HIV care sites, detail substance-specific SUD rates, and identify at-risk patient subgroups.

Resumen

Los esfuerzos previos para estimar la prevalencia de los trastornos por uso de sustancias (TUS) de Estados Unidos en la atención del VIH han sido socavados por los problemas comunes de la investigación realizada en un solo sitio. Este documento informa sobre un estudio de una cohorte de 10,652 adultos con VIH que reciben atención en siete sitios, con los datos del paciente disponibles sobre la geografía, la demografía y los índices de factores de riesgo, y con trastornos por uso de sustancias para sustancias específicas identificadas con los instrumentos de autoinforme con umbrales de diagnóstico que han sido validado. Ecuaciones de estimación generalizadas también evaluaron los índices de pacientes como predictores de TUS. Los resultados fueron: 1) una tasa de prevalencia de TUS de 47 % (entre-ubicación gama de 21 a 71 %), con 20 % de la muestra que demuestra un trastorno que implica múltiples sustancias; 2) las tasas SUD por sustancia específica de 31 % para la marihuana, 19 % para el alcohol, 13 % de la metanfetamina, 11 % de la cocaína, y 4 % de los opiáceos; y 3) el surgimiento de menor edad y el sexo masculino como predictores robustos de los trastornos por uso de sustancias. Los resultados sugieren que los pacientes en las clínicas urbanas VIH tienen altas tasas de TUS, describen las tasas de sustancias específicas, e identifican subgrupos de pacientes en situación de riesgo.

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Acknowledgments

The funding source for this analytic work was National Institute on Drug Abuse R03DA039719 (Informing Dissemination of Behavior Therapies to Enhance HIV Care Among Substance Abusers, Hartzler PI). The authors thank the CNICS sites for contributing data to this endeavor. CNICS is funded by R24 AI067039 with sites at University of Alabama at Birmingham (P30 AI027767), University of Washington (P30 AI027757), University of California San Diego (P30 AI036214), University of California San Francisco (P30 AI027763), Case Western Reserve University (P30 AI036219), John Hopkins University (P30 AI094189, U01 DA036935), Fenway Health/Harvard (P30 AI060354), and University of North Carolina Chapel Hill (P30 AI50410).

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Authors and Affiliations

  1. Alcohol & Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45th Street, Suite 120, Seattle, WA, 98105-4631, USA

    Bryan Hartzler & Dennis M. Donovan

  2. Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA

    Julia C. Dombrowski & Heidi M. Crane

  3. Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Joseph J. Eron & Sonia Napravnik

  4. Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA

    Joseph J. Eron

  5. School of Medicine, University of California, San Francisco, CA, USA

    Elvin H. Geng

  6. Department of Medicine, University of California, San Diego, CA, USA

    W. Christopher Mathews

  7. School of Medicine, Harvard University, Boston, MA, USA

    Kenneth H. Mayer

  8. School of Public Health, Harvard University, Boston, MA, USA

    Kenneth H. Mayer

  9. Department of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Richard D. Moore

  10. Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA

    Richard D. Moore

  11. Center for Global Health, Johns Hopkins University, Baltimore, MD, USA

    Richard D. Moore

  12. Department of Medicine, University of Alabama, Birmingham, AL, UK

    Michael J. Mugavero

  13. Department of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Benigno Rodriguez

  14. Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA

    Dennis M. Donovan

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  1. Bryan Hartzler
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Correspondence to Bryan Hartzler.

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Conflicts of Interest

Julia C. Dombrowski has conducted STD clinical research unrelated to this work supported by grants to the University of Washington from Genentech, ELITech, Melinta Therapeutics, Curatek Pharmaceuticals, Quidel, and Hologic. Among the authorship group, no other conflicts of interest were declared.

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All procedures involving human participants were in accordance with institutional review boards at the CNICS-affiliate universities, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individuals during their initial enrollment in CNICS.

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Hartzler, B., Dombrowski, J.C., Crane, H.M. et al. Prevalence and Predictors of Substance Use Disorders Among HIV Care Enrollees in the United States. AIDS Behav 21, 1138–1148 (2017). https://doi.org/10.1007/s10461-016-1584-6

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