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

Bryan Hartzler; Julia C Dombrowski; Jason R Williams; Heidi M Crane; Joseph J Eron; Elvin H Geng; Christopher Mathews; Kenneth H Mayer; Richard D Moore; Michael J Mugavero; Sonia Napravnik; Benigno Rodriguez; Dennis M Donovan

doi:10.1007/s10461-017-1826-2

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.

Authors

Bryan Hartzler¹, Julia C Dombrowski², Jason R Williams³, Heidi M Crane², Joseph J Eron^{4

5}, Elvin H Geng⁶, Christopher Mathews⁷, Kenneth H Mayer^{8

9}, Richard D Moore^{10

11

12}, Michael J Mugavero¹³, Sonia Napravnik⁴, Benigno Rodriguez¹⁴, Dennis M Donovan^{3

15}

Affiliations

¹ Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street Suite 120, Box 354805, Seattle, WA, 98105-4631, USA. hartzb@u.washington.edu.
² Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA.
³ Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street Suite 120, Box 354805, Seattle, WA, 98105-4631, USA.
⁴ Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
⁵ Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
⁶ School of Medicine, University of California, San Francisco, CA, USA.
⁷ Department of Medicine, University of California, San Diego, CA, USA.
⁸ School of Medicine, Harvard University, Boston, MA, USA.
⁹ School of Public Health, Harvard University, Boston, MA, USA.
¹⁰ Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
¹¹ Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
¹² Center for Global Health, Johns Hopkins University, Baltimore, MD, USA.
¹³ Department of Medicine, University of Alabama, Birmingham, AL, USA.
¹⁴ Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
¹⁵ Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.

Abstract

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

Substances

Anti-HIV Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding