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Unhealthy Alcohol and Illicit Drug Use Are Associated With Decreased Quality of HIV Care

Korthuis, P. Todd MD, MPH*; Fiellin, David A. MD; McGinnis, Kathleen A. MS‡,‡‡,‖; Skanderson, Melissa MS; Justice, Amy C. MD, PhD†,§; Gordon, Adam J. MD, MPH‖,¶; Doebler, Donna Almario DrPH, MS, MPH‖,¶; Asch, Steven M. MD, MPH#; Fiellin, Lynn E. MD; Bryant, Kendall PhD**; Gibert, Cynthia L. MD††,‡‡; Crystal, Stephen PhD§§; Goetz, Matthew Bidwell MD‖‖; Rimland, David MD¶¶; Rodriguez-Barradas, Maria C. MD##; Kraemer, Kevin L. MD, MSc

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2012 - Volume 61 - Issue 2 - p 171–178
doi: 10.1097/QAI.0b013e31826741aa
Clinical Science

Background: HIV-infected patients with substance use experience suboptimal health outcomes, possibly because of 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 3410 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 versus not (59.3% vs. 70.0%, P < 0.001) and those using illicit drugs vs. not (57.8% vs. 70.7%, P < 0.001). In multivariable models, unhealthy alcohol use (adjusted β −2.74; 95% confidence interval: −4.23 to −1.25) and illicit drug use (adjusted β −3.51; 95% CI: −4.99 to −2.02) remained inversely associated with the percentage of QIs received.

Conclusions: Although 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.

*Departments of Medicine, and Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR

Departments of General Medicine, and Public Health Division of General Internal Medicine and the Center for Interdisciplinary Research on AIDS, Yale University School of Medicine, New Haven, CT

Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA

§Departments of General Medicine, and Public Health Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT

Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA

Department of Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA

#VA Greater Palo Alto Healthcare System, Stanford University, Palo Alto, CA

**HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD

††VA Medical Center, Washington, DC and

‡‡George Washington University Medical Center, Washington, DC

§§The Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ

‖‖Division of Infectious Diseases, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA

¶¶Department of Medicine, VA Medical Center and Emory University School of Medicine, Atlanta, GA

##Department of Medicine/Section of Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX.

Correspondence to: P. Todd Korthuis, MD, MPH, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code L-475, Portland, OR 97239-3098 (e-mail:

Supported by the National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism Grant U10AA013566; National Institutes of Health, National Institute on Drug Abuse Grant K23 DA019809 (to Dr Korthuis).

The views expressed in this article are those of the authors. No official endorsement by the National Institutes of Health or the Department of Veterans Affairs is intended or should be inferred.

The authors have no conflicts of interest to disclose.

Received March 5, 2012

Accepted June 28, 2012

© 2012 by Lippincott Williams & Wilkins