title: Unhealthy alcohol and illicit drug use are associated with decreased quality of HIV care.
abstract: BACKGROUND
  HIV-infected patients with substance use experience suboptimal health outcomes, possibly because of variations in care.
  
  
  OBJECTIVE
  To assess the association between substance use and the quality of HIV care (QOC) received.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  HIV-infected patients enrolled in the Veterans Aging Cohort Study.
  
  
  METHODS
  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.
authors: Department of Medicine, Oregon Health & Science University, Portland, OR 97239-3098, USA. korthuis@ohsu.edu
authors: P Todd
authors: PT
authors: Korthuis
authors: David A
authors: DA
authors: Fiellin
authors: Kathleen A
authors: KA
authors: McGinnis
authors: Melissa
authors: M
authors: Skanderson
authors: Amy C
authors: AC
authors: Justice
authors: Adam J
authors: AJ
authors: Gordon
authors: Donna Almario
authors: DA
authors: Doebler
authors: Steven M
authors: SM
authors: Asch
authors: Lynn E
authors: LE
authors: Fiellin
authors: Kendall
authors: K
authors: Bryant
authors: Cynthia L
authors: CL
authors: Gibert
authors: Stephen
authors: S
authors: Crystal
authors: Matthew Bidwell
authors: MB
authors: Goetz
authors: David
authors: D
authors: Rimland
authors: Maria C
authors: MC
authors: Rodriguez-Barradas
authors: Kevin L
authors: KL
authors: Kraemer
mesh_terms: D000328:Adult; D000438:Alcohols / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000628:therapy*; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014728:Veterans
chemical_list: D000438:Alcohols; D013287:Illicit Drugs