The roles of heavy drinking and drug use in engagement in HIV care among hospitalized substance using individuals with poorly controlled HIV infection. (1st August 2019)

• Record Type: Journal Article
• Authors: Elliott, Jennifer C.; Critchley, Lacey; Feaster, Daniel J.; Hasin, Deborah S.; Mandler, Raul N.; Osorio, Georgina; Rodriguez, Allan E.; del Rio, Carlos; Metsch, Lisa R.
• Is Part Of: Drug and alcohol dependence. Volume 201(2019)
• Page Start: 171
• Page End: 177
• Publication Date: 2019-08-01
• Subjects: Alcohol -- Drug -- HIV -- Treatment -- Care engagement; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2019.03.024
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Individuals with HIV who use substances evidence less engagement in care. It is unclear whether alcohol or drugs are more disruptive to engagement in HIV care. We compared heavy drinkers, drug users, and those using both on HIV care engagement. Heavy drinkers were least likely to report lifetime HIV care engagement. Drinkers and drug users reported similar recent care and relationship with providers. Abstract: Background: Substance use can reduce care engagement for individuals with HIV. However, little is known as to whether heavy drinkers differ from drug users. This study compares heavy drinkers, drug users, and those drinking heavily and using drugs on their HIV care engagement. Methods: HIV-infected adult inpatients (n = 801; 67% male; 78% Black) from 11 urban hospitals across the United States participated in a multisite clinical trial to improve patient engagement in HIV care and virologic outcomes. All participants drank heavily and/or used drugs, and had poorly controlled HIV. Participants reported care history at baseline. We compared heavy drinkers, drug users, and those both drinking heavily and using drugs (reference group) on their engagement in care. Results: Heavy drinkers reported lowest rates of lifetime HIV care, AOR = 0.59 (95% CI = 0.36, 0.97). Groups did not differ in recent care, prescription of HIV medication, medical mistrust, or patient-provider relationship. Drug users evidenced the best medication adherence, AOR = 2.38 (95% CI = 1.33, 4.23). Exploratory analyses indicated that drinkers had lower initial care engagement, but that it increased more rapidly with duration of known HIV infection, with similar rates of recent care. Drinkers had the lowest CD4 counts (B=-0.28, p < 0.0001), but no difference in viral load. Conclusions: Heavy drinkers were least likely to have ever been in HIV care. More research is needed to determine why heavy drinkers evidence the lowest initial care engagement and current CD4 counts, and whether drinking intervention early in infection may increase HIV care engagement.