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Association of Substance Use Disorders with Engagement in Care and Mortality among a Clinical Cohort of People with HIV in Washington, DC

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Abstract

Substance use disorders (SUDs) are common among people with HIV and can prevent achievement of optimal health outcomes. Using data from a longitudinal HIV cohort study in the District of Columbia (2011–2018), we calculated the prevalence and correlates of SUD (alcohol, stimulant, and/or opioid use disorders) and determined the association of SUD with engagement in HIV care, ART prescription, viral suppression, and mortality. Of 8420 adults, 3168 (37.6%) had a history of any SUD, most commonly history of alcohol use disorder (29.6%). SUDs disproportionately affected Black individuals (aOR 1.33) and heterosexuals (aOR 1.18), and women had a lower risk of SUD (aOR 0.65). SUD was not associated with engagement in care, ART prescription, or viral suppression. SUD was associated with mortality (aHR 1.31). Addressing alcohol use disorder and preventable causes of death among people with HIV and substance use disorders should be priorities for clinical care and public health.

Resumen

Los trastornos por uso de sustancias (TUS) son comunes entre las personas con VIH y pueden impedir el logro de resultados óptimos de salud. Utilizando datos de un estudio sobre VIH de cohorte longitudinal en el Distrito de Columbia (2011–2018), calculamos la prevalencia y los correlatos de TUS (trastornos por consumo de alcohol, estimulantes y/o opioides) y determinamos la asociación de los TUS con la vinculación a cuidado de VIH, prescripción de terapia antirretroviral, supresión viral y mortalidad. De 8420 adultos, 3168 (37.6%) tenían historial de algún TUS, más comúnmente historial de trastorno por consumo de alcohol (29.6%). Los TUS afectaron de manera desproporcionada a las personas negras (aOR 1.33) y a los heterosexuales (aOR 1.18) y las mujeres tenían un riesgo menor de TUS (aOR 0.65). TUS no tuvo asociación estadísticamente significativa con la vinculación a cuidado de VIH, la prescripción de terapia antirretroviral o la supresión viral. TUS se asoció con mortalidad (aHR 1.31). Abordar el trastorno por consumo de alcohol y las causas prevenibles de muerte entre personas con VIH y trastornos por consumo de sustancias debe ser una prioridad para el cuidado clínico y la salud pública.

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Data Availability

The data and code used in this study are not publicly available. For additional information about the DC Cohort Study and contact information for inquiries, please visit the website: https://publichealth.gwu.edu/projects/dc-cohort-longitudinal-hiv-study#home-content.

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Acknowledgements

The authors would like to acknowledge the DC Cohort Study participants for their contribution to the analysis. Data in this manuscript were collected by the DC Cohort Study Group with investigators and research staff located at: Children’s National Medical Center Adolescent (Lawrence D’Angelo) and Pediatric (Natella Rakhmanina) clinics; the Senior Deputy Director of the DC Department of Health HAHSTA (Michael Kharfen); Family and Medical Counseling Service (Michael Serlin); Georgetown University (Princy Kumar); The George Washington University Biostatistics Center (Tsedenia Bezabeh, Susan Reamer, Alla Sapozhnikova, Marinella Temprosa, Nisha Grover, Greg Strylewicz, Kevin (Jiayang) Xiao); The George Washington University Department of Epidemiology (Morgan Byrne, Alan Greenberg, Maria Jaurretche, Paige Kulie, James Peterson) and Department of Biostatistics and Bioinformatics (Yan Ma); The George Washington University Medical Faculty Associates (Hana Akselrod); Howard University Adult Infectious Disease Clinic (Ronald Wilcox, Jhansi Gajjala) and Pediatric Clinic (Sohail Rana); Kaiser Permanente Mid-Atlantic States (Michael Horberg); La Clinica Del Pueblo (Ricardo Fernandez); MetroHealth (Annick Hebou); National Institutes of Health ( Henry Masur); Washington Health Institute (Jose Bordon); Unity Health Care (Gebeyehu Teferi); Veterans Affairs Medical Center (Debra Benator); Washington Hospital Center (Maria Elena Ruiz); and Whitman-Walker Health (Stephen Abbott). The authors would also like to acknowledge Carlos E. Rodriguez-Diaz, MPH, PhD (George Washington University) for his assistance with the Spanish translation of the abstract.

Funding

The DC Cohort is funded by the National Institute of Allergy and Infectious Diseases, 1R24AI152598-01.

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Authors and Affiliations

  1. Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA

    Rupali Kotwal Doshi, Morgan Byrne, Matthew Levy, Leah Varga, Irene Kuo, Amanda D. Castel & Anne K. Monroe

  2. District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD and TB Administration, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA

    Rupali Kotwal Doshi & Leah Varga

  3. Westat, Rockville, MD, USA

    Matthew Levy

  4. Kaiser Permanente Mid-Atlantic States, Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA

    Michael A. Horberg

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  1. Rupali Kotwal Doshi
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Consortia

on behalf of the DC Cohort Executive Committee

Contributions

All authors contributed to the study conception and design. Data analysis was performed by MB. The first draft of the manuscript was written by RKD, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rupali Kotwal Doshi.

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The authors have no relevant financial or non-financial interests to disclose.

Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Boards of George Washington University, DC Department of Health, and individual participating sites with their own IRBs have approved the DC Cohort study.

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Participants in the DC Cohort consent to have their demographic and clinical data electronically and manually abstracted from medical records at the participating sites and entered into a centralized database, for the purposes of research and publication of findings.

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Doshi, R.K., Byrne, M., Levy, M. et al. Association of Substance Use Disorders with Engagement in Care and Mortality among a Clinical Cohort of People with HIV in Washington, DC. AIDS Behav 25, 2289–2300 (2021). https://doi.org/10.1007/s10461-021-03157-4

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