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Author Notes:

P. Todd Korthuis, MD, MPH, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code L-475, Portland, OR 97239-3098 (e-mail: korthuis@ohsu.edu).

The views expressed in this paper are those of the authors.

No official endorsement by the National Institutes of Health or the Department of Veterans Affairs is intended or should be inferred.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Subjects:

Research Funding:

This work was supported by the National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism (U10AA013566).

Dr. Korthuis’ time was supported by the National Institutes of Health, National Institute on Drug Abuse (K23 DA019809).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • alcohol
  • quality of health care
  • HIV
  • quality indicators
  • health care
  • opioid-related disorders
  • HUMAN-IMMUNODEFICIENCY-VIRUS
  • SUBSTANCE-ABUSE TREATMENT
  • ACTIVE ANTIRETROVIRAL THERAPY
  • HEALTH-CARE
  • UNITED-STATES
  • OF-CARE
  • TREATMENT OUTCOMES
  • PERFORMANCE-MEASURES
  • INFECTED PERSONS
  • MEDICAL-CARE

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

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Journal Title:

Journal of Acquired Immune Deficiency Syndromes

Volume:

Volume 61, Number 2

Publisher:

, Pages 171-178

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2012 by Lippincott Williams & Wilkins

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