Influence of Substance Use Disorders on 2-Year HIV Care Retention in the United States

AIDS Behav. 2018 Mar;22(3):742-751. doi: 10.1007/s10461-017-1826-2.


Substance use disorders (SUDs) are thought to predict care discontinuity, though magnitude and substance-specific variance of effects are unclear. This report of analytic work undertaken with a multi-regional American cohort of 9153 care enrollees addresses these gaps. Care retention was computed from 24-month post-linkage clinic visit documentation, with SUD cases identified from patient-report screening instruments. Two generalized estimating equations tested binary and hierarchial SUD predictors of retention, and potential effect modification by patient age-group, sex, and care site. Findings demonstrate: (1) detrimental SUD effect, equivalent to a nine percentage-point decrease in retention, with independent effects of age-group and care site; (2) substance-specific effect of marijuana UD associated with lower retention; and (3) age-modification of each effect on care discontinuity, with SUDs serving as a risk factor among 18-29 year-olds and protective factor among 60+ year-olds. Collective findings document patient attributes as influences that place particular subgroups at-risk to discontinue care.

Keywords: Care retention; HIV care settings; Substance use disorders; United States.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-HIV Agents / therapeutic use*
  • Cohort Studies
  • Female
  • HIV
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • HIV Infections / psychology
  • Humans
  • Male
  • Middle Aged
  • Retention in Care*
  • Risk Factors
  • Substance-Related Disorders / complications*
  • Substance-Related Disorders / epidemiology*
  • United States / epidemiology


  • Anti-HIV Agents