http://www.ncbi.nlm.nih.gov/pubmed/22820808

J Acquir Immune Defic Syndr. 2012 Jul 19. [Epub ahead of print]

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

Korthuis PT, Fiellin DA, McGinnis KA, Skanderson M, Justice AC, Gordon AJ, Doebler DA, Asch SM, Fiellin LE, Bryant K, Gibert CL, Crystal S, Goetz MB, Rimland D, Rodriguez-Barradas MC, Kraemer KL; for the Veterans Aging Cohort Study.

Source

1Oregon Health & Science University, Portland, OR 2Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine, New Haven, CT 3VA Pittsburgh Healthcare System, Pittsburgh, PA 4Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT 5Center for Health Equity Research and Promotion, Pittsburgh VA Healthcare System, Pittsburgh, PA 6Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA 7VA Greater Palo Alto Healthcare System, Stanford University, Palo Alto, CA 8HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD 9VA Medical Center and George Washington University Medical Center, Washington, DC 10The Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 11VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA 12VA Medical Center and Emory University School of Medicine, Atlanta, GA 13Michael E. De Bakey VAMC and Baylor College of Medicine, Houston, TX.

Abstract

BACKGROUND:

HIV-infected patients with substance use experience suboptimal health outcomes, possibly to due to 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 3,410 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 vs. not (59.3% vs. 70.0%, p<.001) and those using illicit drugs vs. not (57.8% vs. 70.7%, p<.001). In multivariable models, unhealthy alcohol use (adjusted β -2.74; 95% CI -4.23, -1.25) and illicit drug use (adjusted β -3.51 95% CI -4.99, -2.02) remained inversely associated with the percentage of QIs received.

CONCLUSIONS:

Though 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.