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AIDS Behav. 2019 Jan;23(1):140-151. doi: 10.1007/s10461-018-2210-6.

Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare.

Author information

1
Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA. emily.williams3@va.gov.
2
Department of Health Services, University of Washington, Seattle, WA, USA. emily.williams3@va.gov.
3
Veterans Aging Cohort Study Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA.
4
Yale University School of Medicine and Public Health, New Haven, CT, USA.
5
Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care System, 1660 S. Columbian Way, S-152, Seattle, WA, 98108, USA.
6
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
7
Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
8
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
9
Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
10
National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA.
11
Kidney Health Research Collaborative, University of California, San Francisco, and VA San Francisco Healthcare System, San Francisco, CA, USA.
12
Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
13
Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
14
Department of Health Services, University of Washington, Seattle, WA, USA.
15
Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, USA.
16
Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Healthcare System - Seattle Division, Seattle, WA, USA.
17
Department of Medicine, University of Washington, Seattle, WA, USA.

Abstract

We evaluated associations between levels of alcohol use and HIV care continuum components using national Veterans Aging Cohort Study data for all patients with HIV and AUDIT-C screening (2/1/2008-9/30/2014). Poisson regression models evaluated associations between alcohol use levels (non-drinking, low-, medium-, high-, and very high-level drinking) and: (1) engagement with care (documented CD4 cells/µl or viral load copies/ml labs), (2) ART treatment (≥ 1 prescription), and (3) viral suppression (HIV RNA < 500 copies/ml) within one year. Among 33,224 patients, alcohol use level was inversely associated with all care continuum outcomes (all p < 0.001). Adjusted prevalence of care engagement ranged from 77.8% (95% CI 77.1-78.4%) for non-drinking to 69.1% (66.6-71.6%) for high-level drinking. The corresponding range for ART treatment was 74.0% (73.3-74.7%) to 60.1% (57.3-62.9%) and for viral suppression was 57.3% (56.5-58.1%) to 38.3% (35.6-41.1%). Greater alcohol use is associated with suboptimal HIV treatment across the HIV care continuum.

KEYWORDS:

Alcohol; Antiretroviral therapy; Care continuum; HIV; Treatment cascade; Viral suppression

PMID:
29995206
PMCID:
PMC6344313
[Available on 2020-01-01]
DOI:
10.1007/s10461-018-2210-6
[Indexed for MEDLINE]

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