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Influence of Substance Use Disorders on 2-Year HIV Care Retention in the United States

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Abstract

Substance use disorders (SUDs) are thought to predict care discontinuity, though magnitude and substance-specific variance of effects are unclear. This report of analytic work undertaken with a multi-regional American cohort of 9153 care enrollees addresses these gaps. Care retention was computed from 24-month post-linkage clinic visit documentation, with SUD cases identified from patient-report screening instruments. Two generalized estimating equations tested binary and hierarchial SUD predictors of retention, and potential effect modification by patient age-group, sex, and care site. Findings demonstrate: (1) detrimental SUD effect, equivalent to a nine percentage-point decrease in retention, with independent effects of age-group and care site; (2) substance-specific effect of marijuana UD associated with lower retention; and (3) age-modification of each effect on care discontinuity, with SUDs serving as a risk factor among 18–29 year-olds and protective factor among 60+ year-olds. Collective findings document patient attributes as influences that place particular subgroups at-risk to discontinue care.

Resumen

Los trastornos de uso de sustancias (TUS) se cree que predicen la discontinuidad del cuidado, aunque la magnitud y la varianza de los efectos de sustancias específicos no son claros. Este informe de trabajo analítico realizado con una multi-regional americano cohorte de 9153 inscritos de cuidado aborda estos brechas. La retención en la atención se calculó utilizando la documentación de la visita clínica registrada 24 meses después de la conexión a la atención, con casos de TUS identificados a partir de las medidas de detección realizadas por los pacientes. Dos ecuaciones de estimacion generalizadas probaron predictores binarios y jeraquicos del efecto de trastornos de uso de sustancias en la retencion, y la modificación del efecto potencial por edad del paciente, sexo y ubicación del cuidado. El análisis demuestra: (1) TUS tuvieron un efecto perjudicial equivalente a una disminución del 9 por ciento en la retención, con efectos independientes de la edad y ubicación del cuidado; (2) El TUS de marihuana tuvo un efecto de la sustancia específico asociado con menor retención; y (3) La edad tuvo un efecto modificador en la discontinuidad del cuidado; TUS fueron un factor de riesgo para los jóvenes de 18 a 29 años y un factor de protección para los mayores de 60 años. Los resultados colectivos documentan los atributos del paciente que influyen en el riesgo de interrupción de la atención para subgrupos particulares.

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Acknowledgements

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, University of Washington, University of California San Diego, University of California San Francisco, Case Western Reserve University, John Hopkins University, Fenway Health/Harvard, and University of North Carolina Chapel Hill.

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The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health.

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Authors and Affiliations

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

    Bryan Hartzler, Jason R. Williams & 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

    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, USA

    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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Corresponding author

Correspondence to Bryan Hartzler.

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Conflict 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.

Ethical Approval

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.

Informed Consent

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

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Hartzler, B., Dombrowski, J.C., Williams, J.R. et al. Influence of Substance Use Disorders on 2-Year HIV Care Retention in the United States. AIDS Behav 22, 742–751 (2018). https://doi.org/10.1007/s10461-017-1826-2

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