The roles of heavy drinking and drug use in engagement in HIV care among hospitalized substance using individuals with poorly controlled HIV infection

•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 HI...

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Bibliographic Details
Published in:Drug and alcohol dependence 2019-08, Vol.201, p.171-177
Main 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.
Format: Article
Language:English
Subjects:
Adult
Alcohol
Alcohol use
Alcoholic Intoxication - epidemiology
Alcoholic Intoxication - psychology
Alcoholic Intoxication - therapy
Care engagement
CD4 antigen
Clinical research
Clinical trials
Cross-Sectional Studies
Drinking behavior
Drug
Drug abuse
Drug addiction
Drug Users - psychology
Drugs
Early intervention
Female
HIV
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - psychology
Hospitalization - trends
Hospitals
Human immunodeficiency virus
Humans
Immune response
Infections
Inpatient care
Male
Medication Adherence - psychology
Methadone
Middle Aged
Patient Participation - psychology
Patient Participation - trends
Patients
Substance abuse
Substance use
Substance-Related Disorders - epidemiology
Substance-Related Disorders - psychology
Substance-Related Disorders - therapy
Treatment
Trust
United States - epidemiology
Viral Load - trends
Young Adult
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Summary:•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. 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. 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. 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 
ISSN:0376-8716
1879-0046
DOI:10.1016/j.drugalcdep.2019.03.024