The roles of heavy drinking and drug use in engagement in HIV care among hospitalized substance using individuals with poorly controlled HIV infection

• Type of Material: Article
• Authors: Carlos del Rio, Emory University; Jennifer C. Elliott, Columbia University; Lacey Critchley, University of Miami; Daniel J. Feaster, University of Miami; Deborah S. Hasin, Columbia University; Raul N. Mandler, National Institute on Drug Abuse; Georgina Osorio, Icahn School of Medicine at Mount Sinai; Allan E. Rodriguez, University of Miami; Lisa R. Metsch, Columbia University
• Language: English
• Date: 2019-08-01
• Publisher: ELSEVIER IRELAND LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Elsevier B.V. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.drugalcdep.2019.03.024
• Title of Journal or Parent Work: DRUG AND ALCOHOL DEPENDENCE
• Volume: 201
• Start Page: 171
• End Page: 177
• Grant/Funding Information: This work was supported by the National Institutes of Health [grants: U10-DA01372011 (Project HOPE -- Hospital Visit as Opportunity for Prevention and Engagement for HIV-Infected Drug Users; Metsch), K23AA023753 (Elliott), R01AA023163 (Hasin)], and the New York State Psychiatric Institute (Hasin).
• Keywords: Alcohol; OUTCOMES; Treatment; HIV; Science & Technology; Life Sciences & Biomedicine; ANTIRETROVIRAL THERAPY; ASSOCIATION; Care engagement; ABUSE; ALCOHOL-USE DISORDERS; AUDIT; IMPACT; Substance Abuse; Psychiatry; Drug; ADHERENCE; PSYCHOMETRIC PROPERTIES
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background: Substance use can reduce care engagement for individuals with HIV. However, little is known as to whether heavy drinkers differ from drug users. This study compares heavy drinkers, drug users, and those drinking heavily and using drugs on their HIV care engagement. Methods: HIV-infected adult inpatients (n = 801; 67% male; 78% Black) from 11 urban hospitals across the United States participated in a multisite clinical trial to improve patient engagement in HIV care and virologic outcomes. All participants drank heavily and/or used drugs, and had poorly controlled HIV. Participants reported care history at baseline. We compared heavy drinkers, drug users, and those both drinking heavily and using drugs (reference group) on their engagement in care. Results: Heavy drinkers reported lowest rates of lifetime HIV care, AOR = 0.59 (95% CI = 0.36, 0.97). Groups did not differ in recent care, prescription of HIV medication, medical mistrust, or patient-provider relationship. Drug users evidenced the best medication adherence, AOR = 2.38 (95% CI = 1.33, 4.23). Exploratory analyses indicated that drinkers had lower initial care engagement, but that it increased more rapidly with duration of known HIV infection, with similar rates of recent care. Drinkers had the lowest CD4 counts (B=-0.28, p < 0.0001), but no difference in viral load. Conclusions: Heavy drinkers were least likely to have ever been in HIV care. More research is needed to determine why heavy drinkers evidence the lowest initial care engagement and current CD4 counts, and whether drinking intervention early in infection may increase HIV care engagement.