title: The role of at-risk alcohol/drug use and treatment in appointment attendance and virologic suppression among HIV(+) African Americans.
abstract: The causes of poor clinic attendance and incomplete virologic suppression among HIV(+) African Americans (AAs) are not well understood. We estimated the effect of at-risk alcohol/drug use and associated treatment on attending scheduled appointments and virologic suppression among 576 HIV(+) AA patients in the University of Alabama at Birmingham (UAB) 1917 Clinic Cohort who contributed 591 interviews to the analysis. At interview, 78% of patients were new to HIV care at UAB, 38% engaged in at-risk alcohol/drug use or received associated treatment in the prior year, while the median (quartiles) age and CD4 count were 36 (28; 46) years and 321 (142; 530) cells/μl, respectively. In the 2 years after an interview, half of the patients had attended at least 82% of appointments while half had achieved virologic suppression for at least 71% of RNA assessments. Compared to patients who did not use or receive treatment, the adjusted risk ratio (aRR) for attending appointments for patients who did use but did not receive treatment was 0.97 (95% confidence limits: 0.92, 1.03). The corresponding aRR for virologic suppression was 0.94 (0.86, 1.03). Compared to patients who did not receive treatment but did use, the aRR for attending appointments for patients who did receive treatment and did use was 0.86 (0.78, 0.95). The corresponding aRR for virologic suppression was 1.07 (0.92, 1.24). Use was negatively associated with attendance and virologic suppression among patients not in treatment. Among users, treatment was negatively associated with attendance yet positively associated with virologic suppression. However, aRR estimates were imprecise.
authors: 1 Department of Epidemiology, Center for Population Health and Clinical Epidemiology, Brown University School of Public Health , Providence, Rhode Island.
authors: Chanelle J
authors: CJ
authors: Howe
authors: Stephen R
authors: SR
authors: Cole
authors: Sonia
authors: S
authors: Napravnik
authors: Jay S
authors: JS
authors: Kaufman
authors: Adaora A
authors: AA
authors: Adimora
authors: Beth
authors: B
authors: Elston
authors: Joseph J
authors: JJ
authors: Eron
authors: Michael J
authors: MJ
authors: Mugavero
mesh_terms: D000328:Adult; D001741:Black or African American; D000407:Alabama; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000150:complications*; D019562:Viral Load; D016903:Drug Monitoring