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Studies reveal wide use of drugs and alcohol and underuse of substance abuse treatment by those with HIV disease

Among patients with HIV disease, alcohol and drug use is linked to lower adherence to antiretroviral drug regimens and worse HIV-related outcomes. Nevertheless, use of drugs and alcohol is prevalent among individuals living with HIV disease, yet few receive substance abuse treatment, according to two studies supported in part by the Agency for Healthcare Research and Quality (Contract 290-01-0012).

The two studies are described here.

Chander, G., Josephs, J., Fleishman, J., and others (2008, April). "Alcohol use among HIV-infected persons in care: Results of a multi-site survey." HIV Medicine 9(4), pp.196-202.

In this study, the researchers interviewed 951 patients at 14 HIV primary care sites in the United States about their drinking behavior. They defined hazardous drinking as more than 14 drinks per week or 5 or more drinks on 1 occasion for men and more than 7 drinks per week or 4 or more drinks per occasion for women. Anything less was considered moderate consumption. The authors examined the correlates of any use of alcohol and of hazardous alcohol use. Overall, 40 percent of those interviewed reported some alcohol use in the 4 weeks prior to the interview; 11 percent reported hazardous use and 29 percent reported moderate drinking levels. After adjusting for other factors, male sex increased the odds of any alcohol use by 52 percent, a college education nearly doubled the odds compared with less than high school education, and current illicit drug use nearly tripled the odds. A lowest CD4 cell count of 500 cells/uL or more (indicating better immune system function) and current illicit drug use nearly tripled the odds of hazardous alcohol use. In contrast, patients who made more than seven primary care visits had lower odds of hazardous alcohol use.

Korthuis, P.T., Josephs, J.S., Fleishman, J.A., and others (2008, March). "Substance abuse treatment in human immunodeficiency virus: The role of patient-provider discussions." Journal of Substance Abuse Treatment.

The researchers surveyed 951 HIV-infected adults (predominantly minority men) receiving care at 14 HIV Research Network primary care sites about their drug and alcohol use, substance abuse treatment, and provider discussions about substance use issues. Overall, 71 percent of patients reported current or former illicit drug use, and 11 percent of illicit drug users reported hazardous or binge drinking (HBD). Less than half (46 percent) of current or former substance users reported discussing substance use issues with their HIV care providers. Yet provider discussions of substance use issues doubled the odds that individuals would receive substance abuse treatment.

Receipt of transportation assistance and black race also doubled the odds of receiving substance abuse treatment. Patients who reported current drug use, more severe drug use, and HBD were more likely to report discussing substance use issues with their provider, as were younger and unemployed patients and those who made six or seven visits to their primary care provider in the previous 6 months. Although blacks reported substance abuse no more often than whites (72 vs. 75 percent), blacks were 72 percent more likely to have discussions with their provider about substance use. This finding is similar to profiling of minority patients for substance use discussions documented in emergency room visits.

Reprints of both studies (AHRQ Publication Nos. 08-R067 and 08-R066) are available from the AHRQ Publications Clearinghouse.

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