Unhealthy Alcohol and Illicit Drug Use are Associated with Decreased Quality of HIV Care

• Type of Material: Article
• Authors: P. Todd Korthuis, Oregon Health and Science University; David A. Fiellin, Yale University; Kathleen A. McGinnis, VA Pittsburgh Healthcare System; Melissa Skanderson, VA Pittsburgh Healthcare System; Amy C. Justice, Yale University; Adam J. Gordon, VA Pittsburgh Healthcare System; Donna Almario Doebler, VA Pittsburgh Healthcare System; Steven M. Asch, Stanford University; Lynn E. Fiellin, Yale University; Kendall Bryant, National Institute on Alcohol Abuse and Alcoholism; Cynthia L. Gibert, VA Medical Center; Stephen Crystal, Rutgers State University; Matthew Bidwell Goetz, University of California at Los Angeles; David Rimland, Emory University; Maria C. Rodriguez-Barradas, Michael E. De Bakey VA Medical Center; Kevin L. Kraemer, University of Pittsburgh
• Language: English
• Date: 2012-10-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 by Lippincott Williams & Wilkins
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0b013e31826741aa
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 61
• Issue: 2
• Start Page: 171
• End Page: 178
• Grant/Funding Information: Dr. Korthuis’ time was supported by the National Institutes of Health, National Institute on Drug Abuse (K23 DA019809).; This work was supported by the National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism (U10AA013566).
• Keywords: HIV; health care; HEALTH-CARE; INFECTED PERSONS; TREATMENT OUTCOMES; HUMAN-IMMUNODEFICIENCY-VIRUS; Immunology; Life Sciences & Biomedicine; alcohol; Science & Technology; OF-CARE; UNITED-STATES; quality of health care; quality indicators; ACTIVE ANTIRETROVIRAL THERAPY; SUBSTANCE-ABUSE TREATMENT; MEDICAL-CARE; Infectious Diseases; opioid-related disorders; PERFORMANCE-MEASURES
• Research Categories: Health Sciences, Epidemiology; Health Sciences, General; Health Sciences, Immunology

Abstract

HIV-infected patients with substance use experience suboptimal health outcomes, possibly because of variations in care. OBJECTIVES: To assess the association between substance use and the quality of HIV care (QOC) received. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: HIV-infected patients enrolled in the Veterans Aging Cohort Study. MEASURES: We collected self-report substance use data and abstracted 9 HIV quality indicators (QIs) from medical records. Independent variables were unhealthy alcohol use (AUDIT-C score ≥4) and illicit drug use (self-report of stimulants, opioids, or injection drug use in past year). Main outcome was the percentage of QIs received, if eligible. We estimated associations between substance use and QOC using multivariable linear regression. RESULTS: The majority of the 3410 patients were male (97.4%) and black (67.0%) with a mean age of 49.1 years (SD = 8.8). Overall, 25.8% reported unhealthy alcohol use, 22% illicit drug use, and participants received 81.5% (SD = 18.9) of QIs. The mean percentage of QIs received was lower for those with unhealthy alcohol use versus not (59.3% vs. 70.0%, P < 0.001) and those using illicit drugs vs. not (57.8% vs. 70.7%, P < 0.001). In multivariable models, unhealthy alcohol use (adjusted β-2.74; 95% confidence interval:-4.23 to-1.25) and illicit drug use (adjusted β-3.51; 95% CI:-4.99 to-2.02) remained inversely associated with the percentage of QIs received. CONCLUSIONS: Although the overall QOC for these HIV-infected Veteran patients was high, gaps persist for those with unhealthy alcohol and illicit drug use. Interventions that address substance use in HIV-infected patients may improve the QOC received.