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

  • Bryan Hartzler
  • Julia C. Dombrowski
  • Jason R. Williams
  • Heidi M. Crane
  • Joseph J. Eron
  • Elvin H. Geng
  • Christopher Mathews
  • Kenneth H. Mayer
  • Richard D. Moore
  • Michael J. Mugavero
  • Sonia Napravnik
  • Benigno Rodriguez
  • Dennis M. Donovan
Original Paper

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.

Keywords

HIV care settings Substance use disorders Care retention United States 

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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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Bryan Hartzler
    • 1
  • Julia C. Dombrowski
    • 2
  • Jason R. Williams
    • 1
  • Heidi M. Crane
    • 2
  • Joseph J. Eron
    • 3
    • 4
  • Elvin H. Geng
    • 5
  • Christopher Mathews
    • 6
  • Kenneth H. Mayer
    • 7
    • 8
  • Richard D. Moore
    • 9
    • 10
    • 11
  • Michael J. Mugavero
    • 12
  • Sonia Napravnik
    • 3
  • Benigno Rodriguez
    • 13
  • Dennis M. Donovan
    • 1
    • 14
  1. 1.Alcohol & Drug Abuse InstituteUniversity of WashingtonSeattleUSA
  2. 2.Division of Allergy and Infectious DiseaseUniversity of WashingtonSeattleUSA
  3. 3.Department of MedicineUniversity of North CarolinaChapel HillUSA
  4. 4.Department of EpidemiologyUniversity of North CarolinaChapel HillUSA
  5. 5.School of MedicineUniversity of CaliforniaSan FranciscoUSA
  6. 6.Department of MedicineUniversity of CaliforniaSan DiegoUSA
  7. 7.School of MedicineHarvard UniversityBostonUSA
  8. 8.School of Public HealthHarvard UniversityBostonUSA
  9. 9.Department of MedicineJohns Hopkins UniversityBaltimoreUSA
  10. 10.Department of EpidemiologyJohns Hopkins UniversityBaltimoreUSA
  11. 11.Center for Global HealthJohns Hopkins UniversityBaltimoreUSA
  12. 12.Department of MedicineUniversity of AlabamaBirminghamUSA
  13. 13.Department of MedicineCase Western Reserve UniversityClevelandUSA
  14. 14.Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA

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