Skip to main content

Substance Use Screening in HIV Care Settings: a Review and Critique of the Literature

Current HIV/AIDS Reports volume 16, pages 7–16 (2019)Cite this article

Abstract

Purpose of Review

People living with human immunodeficiency virus/AIDS (PLWHA) experience high prevalence of substance use disorders (SUD). HIV care settings represent a unique opportunity to identify possible SUD, to provide SUD interventions, and to improve linkage to SUD treatment. The aims of this paper are to (a) review and critique the extant literature examining substance use screening approaches among PLWHA in HIV care settings and (b) provide recommendations for future clinical practice.

Recent Findings

Twenty-one peer-reviewed articles that examined substance screening approaches employed in HIV and other primary care settings were included in the review. There was limited literature reporting on the implementation and evaluation of substance use screening practices within HIV care settings, and methodological rigor varied across studies. Further, the use of validated substance use screening measures or incorporation of other substance use screening approaches (e.g., use of urine drug testing) within routine HIV care practice is limited. Strategies to implement routine substance use screening within HIV care and incorporate additional substance use assessment, brief interventions, and referral to specialty substance use treatment are discussed.

Summary

Use of self-report substance use screening measures using web- or computer-delivered approaches that can be integrated within electronic health record systems is particularly promising. HIV care practices should consider potential models to optimally screen and treat SUD. Co-location of HIV and SUD treatment services may be optimal; when co-located services are not possible, strategies to consistently provide brief intervention approaches and referrals to specialty SUD treatment are needed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. CDC. HIV Surveillance Report, 2014. 2015.

  2. Galvan FH, Bing EG, Fleishman JA, London AS, Caetano R, Burnam MA, et al. The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV. J Stud Alcohol. 2002;63(2):179–86.

    Article  Google Scholar 

  3. Skalski LM, Watt MH, MacFarlane JC, Proeschold-Bell RJ, Stout JE, Sikkema KJ. Mental health and substance use among patients in a North Carolina HIV clinic. N C Med J. 2015;76(3):148–55.

    PubMed  PubMed Central  Google Scholar 

  4. Substance Abuse and Mental Health Services Administration. The NSDUH report: HIV/AIDS and substance use. 2010.

  5. Hartzler B, Dombrowski JC, Crane HM, Eron JJ, Geng EH, Christopher Mathews W, et al. Prevalence and predictors of substance use disorders among HIV care enrollees in the United States. AIDS Behav. 2017;21(4):1138–48.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ompad DC, Giobazolia TT, Barton SC, Halkitis SN, Boone CA, Halkitis PN, et al. Drug use among HIV+ adults aged 50 and older: findings from the GOLD II study. AIDS Care. 2016;28(11):1373–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Pacek LR, Harrell PT, Martins SS. Cigarette smoking and drug use among a nationally representative sample of HIV-positive individuals. Am J Addict. 2014;23(6):582–90.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gamarel KE, Brown L, Kahler CW, Fernandez MI, Bruce D, Nichols S. Prevalence and correlates of substance use among youth living with HIV in clinical settings. Drug Alcohol Depend. 2016;169:11–8.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kalichman SC, Washington C, Kegler C, Grebler T, Kalichman MO, Cherry C, et al. Continued substance use among people living with HIV–hepatitis-C co-infection and receiving antiretroviral therapy. Subst Use Misuse. 2015;50(12):1536–43.

    Article  PubMed  PubMed Central  Google Scholar 

  10. O’Cleirigh C, Magidson JF, Skeer MR, Mayer KH, Safren SA. Prevalence of psychiatric and substance abuse symptomatology among HIV-infected gay and bisexual men in HIV primary care. Psychosomatics. 2015;56(5):470–8.

    Article  PubMed  Google Scholar 

  11. Durvasula R, Miller TR. Substance abuse treatment in persons with HIV/AIDS: challenges in managing triple diagnosis. Behav Med. 2014;40(2):43–52.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Saag LA, Tamhane AR, Batey DS, Mugavero MJ, Eaton EF. Mental health service utilization is associated with retention in care among persons living with HIV at a university-affiliated HIV clinic. AIDS Res Ther. 2018;15:1–10.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Burnett JC, Broz D, Spiller MW, Wejnert C, Paz-Bailey G. HIV infection and HIV-associated behaviors among persons who inject drugs—20 cities, United States, 2015. MMWR Morb Mortal Wkly Rep. 2018;67(1):23–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Des Jarlais DC, Arasteh K, Perlis T, Hagan H, Abdul-Quader A, Heckathorn DD, et al. Convergence of HIV seroprevalence among injecting and non-injecting drug users in New York City. AIDS. 2007;21(2):231–5.

    Article  PubMed  Google Scholar 

  15. Bradley-Springer L. 100% HIV prevention: missed opportunities for injection drug users? J Assoc Nurses AIDS Care. 2015;26(5):503–5.

    Article  PubMed  Google Scholar 

  16. Morin S, Myers J, Shade S, Koester K, Maiorana A, Rose C. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav. 2007;11(5):6–16.

    Article  Google Scholar 

  17. Gorbach PM, Drumright LN, Javanbakht M, Pond SL, Woelk CH, Daar ES, et al. Antiretroviral drug resistance and risk behavior among recently HIV-infected men who have sex with men. J Acquir Immune Defic Syndr. 2008;47(5):639–43.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gerbi GB, Habtemariam T, Tameru B, Nganwa D, Robnett V. A comparative study of substance use before and after establishing HIV infection status among people living with HIV/AIDS. J Subst Abus. 2011;16(6):464–75.

    Google Scholar 

  19. Khan MR, Berger A, Hemberg J, O’Neill A, Dyer TP, Smyrk K. Non-injection and injection drug use and STI/HIV risk in the United States: the degree to which sexual risk behaviors versus sex with an STI-infected partner account for infection transmission among drug users. AIDS Behav. 2013;17(3):1185–94.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Swendsen J, Conway KP, Degenhardt L, Glantz M, Jin R, Merikangas KR, et al. Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Addiction. 2010;105(6):1117–28.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Klinkenberg WD, Sacks S, for the Hiv/aids Treatment Adherence HO, Cost Study G. Mental disorders and drug abuse in persons living with HIV/AIDS. AIDS Care. 2004;16:22–42.

    Article  Google Scholar 

  22. Stoff DM, Mitnick L, Kalichman S. Research issues in the multiple diagnoses of HIV/AIDS, mental illness and substance abuse. AIDS Care. 2004;16(Suppl 1):S1–5.

    PubMed  Google Scholar 

  23. Adams C, Zacharia S, Masters L, Coffey C, Catalan P. Mental health problems in people living with HIV: changes in the last two decades: the London experience 1990–2014. AIDS Care. 2016;28:56–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pence BW, Miller WC, Whetten K, Eron JJ, Gaynes BN. Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the Southeastern United States. J Acquir Immune Defic Syndr. 2006;42(3):298–306.

    Article  PubMed  Google Scholar 

  25. Walkup J, Blank MB, Gonzalez JS, Safren S, Schwartz R, Brown L, et al. The impact of mental health and substance abuse factors on HIV prevention and treatment. J Acquir Immune Defic Syndr. 2008;47:S15–S9.

    Article  PubMed  Google Scholar 

  26. Rezaei S, Taramian S, Kafie SM. Psychopathological dimensions in substance abusers with and without HIV/AIDS and healthy matched group. Addict Health. 2013;5(3–4):115.

    PubMed  PubMed Central  Google Scholar 

  27. Gamarel KE, Nichols S, Kahler CW, Westfall AO, Lally MA, Wilson CM. A cross-sectional study examining associations between substance use frequency, problematic use and STIs among youth living with HIV. Sex Transm Infect. 2017;169:11–8.

  28. DeLorenze GN, Weisner C, Tsai A-L, Satre DD, Quesenberry CP Jr. Excess mortality among HIV-infected patients diagnosed with substance use dependence or abuse receiving care in a fully integrated medical care program. Alcohol Clin Exp Res. 2011;35(2):203–10.

    Article  PubMed  Google Scholar 

  29. Keen LL, Khan M, Clifford L, Harrell PT, Latimer WW. Injection and non-injection drug use and infectious disease in Baltimore City: differences by race. Addict Behav. 2014;39(9):1325–8.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Carrico AW. Substance use and HIV disease progression in the HAART era: implications for the primary prevention of HIV. Life Sci. 2011;88(21–22):940–7.

    Article  CAS  Google Scholar 

  31. Kuchinad KE, Hutton HE, Monroe AK, Anderson G, Moore RD, Chander G. A qualitative study of barriers to and facilitators of optimal engagement in care among PLWH and substance use/misuse. BMC Res Notes. 2016;9:229.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Colasanti J, Stahl N, Farber EW, Del Rio C, Armstrong WS. An exploratory study to assess individual and structural level barriers associated with poor retention and re-engagement in care among persons living with HIV/AIDS. J Acquir Immune Defic Syndr. 2017;74(Suppl 2):S113–S20.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gonzalez A, Barinas J, O’Cleirigh C. Substance use: impact on adherence and HIV medical treatment. Curr HIV/AIDS Rep. 2011;8(4):223–34.

    Article  PubMed  Google Scholar 

  34. Moore RD, Keruly JC, Chaisson RE. Differences in HIV disease progression by injecting drug use in HIV-infected persons in care. J Acquir Immune Defic Syndr. 2004;35(1):46–51.

    Article  PubMed  Google Scholar 

  35. Carrico AW, Johnson MO, Moskowitz JT, Neilands TB, Morin SF, Charlebois ED, et al. Affect regulation, stimulant use, and viral load among HIV-positive persons on anti-retroviral therapy. Psychosom Med. 2007;69(8):785–92.

    Article  PubMed  Google Scholar 

  36. Baum MK, Rafie C, Lai S, Sales S, Page B, Campa A. Crack-cocaine use accelerates HIV disease progression in a cohort of HIV-positive drug users. J Acquir Immune Defic Syndr. 2009;50(1):93–9.

    Article  PubMed  Google Scholar 

  37. Cook JA, Burke-Miller JK, Cohen MH, Cook RL, Vlahov D, Wilson TE, et al. Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women. AIDS. 2008;22(11):1355–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Kalichman SC. Co-occurrence of treatment nonadherence and continued HIV transmission risk behaviors: implications for positive prevention interventions. Psychosom Med. 2008;70(5):593–7.

    Article  PubMed  Google Scholar 

  39. Sobell LC, Sobell MB. Timeline follow-back: a technique for assessing self-reported alcohol consumption. In: Litten RZ, Allen JP, Litten RZ, Allen JP, editors. Measuring alcohol consumption: psychosocial and biochemical methods. Totowa: Humana Press; 1992. p. 41–72.

    Chapter  Google Scholar 

  40. Rosenbaum A, Rabenhorst MM, Reddy MK, Fleming MT, Howells NL. A comparison of methods for collecting self-report data on sensitive topics. Violence Vict. 2006;21(4):461–71.

    Article  PubMed  Google Scholar 

  41. Messer LC, Quinlivan EB, Parnell H, Roytburd K, Adimora AA, Bowditch N, et al. Barriers and facilitators to testing, treatment entry, and engagement in care by HIV-positive women of color. AIDS Patient Care STDs. 2013;27(7):398–407.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, et al. The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. Am J Public Health. 2015;105(2):e75–82.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Beer L, Fagan JL, Valverde E, Bertolli J. Health-related beliefs and decisions about accessing HIV medical care among HIV-infected persons who are not receiving care. AIDS Patient Care STDs. 2009;23(9):785–92.

    Article  PubMed  Google Scholar 

  44. • Delker E, Aharonovich E, Hasin D. Interviewer-administered TLFB vs. self-administered computerized (A-CASI) drug use frequency questions: a comparison in HIV-infected drug users. Drug Alcohol Depend. 2016;161:29–35. The authors examined agreement between two substance use assessment modalities, interview-administered Timeline Follow-Back and self-administered ACASI in a sample of PLWHA .

    Article  PubMed  PubMed Central  Google Scholar 

  45. Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA. 1999;281:283–7.

    Article  CAS  PubMed  Google Scholar 

  46. • Fredericksen R, Crane PK, Tufano J, Ralston J, Schmidt S, Brown T, et al. Integrating a web-based, patient-administered assessment into primary care for HIV-infected adults. J AIDS HIV Res. 2012;4(2):47–55. The authors examined the feasiblity of a web-based, self-administered patient reported substance use assessment measure in an HIV care setting and identified factors associated with successful integration of the screening approach .

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Ewing JA. Detecting Alcoholism. The CAGE Questionnaire. J Am Med Assoc. 1984;252(14):1905–7.

  48. Metsch LR, Pereyra M, Colfax G, Dawson-Rose C, Cardenas G, McKirnan D, et al. HIV-positive patients’ discussion of alcohol use with their HIV primary care providers. Drug Alcohol Depend. 2008;95(1–2):37–44.

    Article  PubMed  Google Scholar 

  49. Malbergier A, Cardoso LRD, Amaral RA. Adolescent substance use and family problems. Cad Saude Publica. 2012;28(4):678–88.

    Article  PubMed  Google Scholar 

  50. Eyawo O, McGinnis KA, Justice AC, Fiellin DA, Hahn JA, Williams EC, et al. Alcohol and mortality: combining self-reported (AUDIT-C) and biomarker detected (PEth) alcohol measures among HIV infected and uninfected. J Acquir Immune Defic Syndr. 2018;77(2):135–43.

    PubMed  PubMed Central  Google Scholar 

  51. Littlefield A, Brown J, Diclemente R, Safonova P, Sales J, Rose E, et al. Phosphatidylethanol (PEth) as a biomarker of alcohol consumption in HIV-infected young Russian women: comparison to self-report assessments of alcohol use. AIDS Behav. 2017;21(7):1938–49.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med. 2002;156(6):607–14.

    Article  PubMed  Google Scholar 

  53. Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, et al. Two brief alcohol-screening tests from the alcohol use disorders identification test (AUDIT): validation in a female veterans affairs patient population. Arch Intern Med. 2003;163(7):821–9.

    Article  PubMed  Google Scholar 

  54. Surah S, Kieran J, O’Dea S, Shiel C, Raffee S, Mulcahy F, et al. Use of the Alcohol Use Disorders Identification Test (AUDIT) to determine the prevalence of alcohol misuse among HIV-infected individuals. Int J STD AIDS. 2013;24(7):517–21.

    Article  CAS  PubMed  Google Scholar 

  55. The Alcohol, Smoking and Substance Abuse Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction (Abingdon, England). 2002;97(9):1183–94.

  56. Machado IK, Luz PM, Lake JE, Castro R, Velasque L, Clark JL, et al. Self-rated health and substance use among individuals in HIV care in Rio de Janeiro, Brazil: a cross-sectional study. Int J STD AIDS. 2017;28(12):1175–83.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252:1905–7.

    Article  CAS  Google Scholar 

  58. Samet JH, Phillips SJ, Horton NJ, Traphagen ET, Freedberg KA. Detecting alcohol problems in HIV-infected patients: use of the CAGE questionnaire. AIDS Res Hum Retrovir. 2004;20(2):151–5.

    Article  PubMed  Google Scholar 

  59. Skinner HA. Drug abuse screening test. The Drug Abuse Screening Test 1982;7(4):363–71.

  60. Parsons JT, Starks TJ, Millar BM, Boonrai K, Marcotte D. Patterns of substance use among HIV-positive adults over 50: implications for treatment and medication adherence. Drug Alcohol Depend. 2014;139:33–40.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Pence BW, Gaynes BN, Whetten K, Eron JJ Jr, Ryder RW, Miller WC. Validation of a brief screening instrument for substance abuse and mental illness in HIV-positive patients. J Acquir Immune Defic Syndr. 2005;40(4):434–44.

    Article  PubMed  Google Scholar 

  62. Whetten K, Reif S, Swartz M, Stevens R, Ostermann J, Hanisch L, et al. A brief mental health and substance abuse screener for persons with HIV. AIDS Patient Care STDs. 2005;19(2):89–99.

    Article  PubMed  Google Scholar 

  63. Valderas JM, Kotzeva A, Espallargues M, Guyatt G, Ferrans CE, Halyard MY, et al. The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res. 2008;17(2):179–93.

    Article  CAS  Google Scholar 

  64. Perlman DC, Jordan AE. Considerations for the development of a substance-related care and prevention continuum model. Front Public Health. 2017;5:180.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Miller WR, Baca C, Compton WM, Ernst D, Manuel JK, Pringle B, et al. Addressing substance abuse in health care settings. Alcohol Clin Exp Res. 2006;30(2):292–302.

    Article  PubMed  Google Scholar 

  66. Saitz R, Alford DP, Bernstein J, Cheng DM, Samet J, Palfai T. Screening and brief intervention for unhealthy drug use in primary care settings: randomized clinical trials are needed. J Addict Med. 2010;4(3):123–30.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Graham LJ, Davis AL, Cook PF, Weber M. Screening, brief intervention, and referral to treatment in a rural Ryan White Part C HIV clinic. AIDS Care. 2016;28(4):508–12.

    Article  PubMed  Google Scholar 

  68. Saitz R, Palfai TPA, Cheng DM, Alford DP, Bernstein JA, Lloyd-Travaglini CA, et al. Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial. JAMA. 2014;312(5):502–13.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Humeniuk R, Ali R, Babor T, Souza-Formigoni MLO, de Lacerda RB, Ling W, et al. A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries. Addiction. 2012;107(5):957–66.

    Article  PubMed  Google Scholar 

  70. Savage CL, Sanchez M. Alcohol and substance use disorder screening, brief intervention, and referral to treatment among people living with HIV/AIDS. J Addict Nurs. 2016;27(3):214–7.

    Article  PubMed  Google Scholar 

  71. Dawson Rose C, Cuca YP, Kamitani E, Eng S, Zepf R, Draughon J, et al. Using interactive web-based screening, brief intervention and referral to treatment in an urban, safety-net HIV clinic. AIDS Behav. 2015;19(Suppl 2):186–93.

    Article  PubMed  Google Scholar 

  72. Cropsey KL, Hendricks PS, Jardin B, Clark CB, Katiyar N, Willig J, et al. A pilot study of screening, brief intervention, and referral for treatment (SBIRT) in non-treatment seeking smokers with HIV. Addict Behav. 2013;38(10):2541–6.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Hasin DS, Aharonovich E, O’Leary A, Greenstein E, Pavlicova M, Arunajadai S, et al. Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement. Addiction. 2013;108(7):1230–40.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Aharonovich E, Greenstein E, O’Leary A, Johnston B, Seol SG, Hasin DS. HealthCall: technology-based extension of motivational interviewing to reduce non-injection drug use in HIV primary care patients—a pilot study. AIDS Care. 2012;24(12):1461–9.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(2011):383–94.

    Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Psychology, University of Cincinnati, 3131 Harvey Avenue, Suite 104, Cincinnati, OH, 45208, USA

    Anthony E. Hitch & Nicole K. Gause

  2. Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Jennifer L. Brown

Authors
  1. Anthony E. Hitch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicole K. Gause
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer L. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anthony E. Hitch.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Behavioral-Bio-Medical Interface

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hitch, A.E., Gause, N.K. & Brown, J.L. Substance Use Screening in HIV Care Settings: a Review and Critique of the Literature. Curr HIV/AIDS Rep 16, 7–16 (2019). https://doi.org/10.1007/s11904-019-00434-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11904-019-00434-9

Keywords

  • Substance use
  • HIV/AIDS
  • Screening
  • Screening, brief intervention, and referral to treatment (SBIRT)
  • Primary care