Among patients with unhealthy alcohol use, those with HIV are less likely than those without to receive evidence-based alcohol-related care: A national VA study. (1st May 2017)

• Record Type: Journal Article
• Authors: Williams, Emily C.; Lapham, Gwen T.; Shortreed, Susan M.; Rubinsky, Anna D.; Bobb, Jennifer F.; Bensley, Kara M.; Catz, Sheryl L.; Richards, Julie E.; Bradley, Katharine A.
• Is Part Of: Drug and alcohol dependence. Volume 174(2017)
• Page Start: 113
• Page End: 120
• Publication Date: 2017-05-01
• Subjects: Alcohol -- HIV -- Brief intervention -- Alcohol use disorders -- Disparities; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2017.01.018
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Disparities in receipt of alcohol-related care among HIV+ and HIV- patients exist. Alcohol use is disproportionality under-addressed among PLWH relative to HIV-. Special efforts may be needed to ensure that HIV+ patients receive adequate care. Abstract: Background: Alcohol use has important adverse effects on people living with HIV (PLWH). This study of patients with recognized unhealthy alcohol use estimated and compared rates of alcohol-related care received by PLWH and HIV- patients. Methods: Outpatients from the Veterans Health Administration who had one or more positive screen(s) for unhealthy alcohol use (AUDIT-C ≥ 5) documented in their medical records 10/2009-5/2013 were eligible. Primary and secondary outcomes were brief intervention documented ≤14 days after a positive alcohol screen, and a composite measure of any alcohol-related care (brief intervention, specialty addictions treatment or pharmacotherapy documented ≤365 days), respectively. Unadjusted and adjusted regression analyses compared alcohol-related care outcomes in PLWH and HIV- patients. Results: The sample included 830, 825 outpatients (3, 514 PLWH), reflecting 1, 172, 606 positive screens (1–5 per patient). For PLWH, 57.0% (95% confidence interval 55.4–58.5%) of positive screens were followed by brief intervention, compared to 73.8% (73.7–73.9%) for HIV- patients [relative rate: 0.77 (0.75–0.79), p < 0.001]. After adjustment, comparable proportions were 61.0% (59.3–62.6%) for PLWH and 73.7% (73.6–73.8%) for HIV- patients [adjusted RR = 0.83 (0.80–0.85); p < 0.001]. Secondary outcome results were similar: for PLWH and HIV- patients, 67.1% (65.7–68.6%) and 77.7% (95% CI 77.7–77.8%) of positive screens, respectively, were followed by any alcohol-related care after adjustment [adjusted RR = 0.86 (0.85–0.88), p < 0.001]. Conclusions: In this large national sample of VA outpatients with unhealthy alcohol use, PLWH were less likely to receive alcohol-related care than HIV- patients. Special efforts may be needed to ensure alcohol-related care reaches PLWH.