title: Daily Marijuana Use is Associated with Missed Clinic Appointments Among HIV-Infected Persons Engaged in HIV Care.
abstract: We assessed the association between marijuana use and retention in HIV care through a retrospective cohort study of patients engaged in care at a large HIV clinic in 2011 and 2012. Two different retention outcomes were assessed: not meeting the Institute of Medicine's (IOM) retention definition (≥2 provider visits ≥90 days apart in a calendar year) and no-show visits. Any marijuana use and frequency of marijuana use were obtained from a substance use screening questionnaire administered at each clinic visit. Modified Poisson regression was used to estimate risk ratios and 95% confidence intervals for the association between marijuana use and retention outcomes. Marijuana use was reported by 17% of 1791 patients and 21% were not retained (IOM definition). Marijuana use was not associated with the IOM retention outcome, but was associated with missing the next scheduled appointment. A non-linear dose-response was observed for frequency of marijuana use and missed visits, with daily users having the highest risk compared to non-users. Daily marijuana use had a negative impact on HIV clinic attendance. Further research is needed to elucidate the mechanisms by which marijuana use affects this outcome to inform targeted interventions.
authors.affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. aaron.kipp@Vanderbilt.Edu.|Vanderbilt Institute for Medicine and Public Health, 2525 West End Ave., Suite 614, Nashville, TN, 37203, USA. aaron.kipp@Vanderbilt.Edu.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Kipp
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rebeiro
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.affiliation: Institute for Community Health Promotion, School of Public Health, Brown University, Providence, RI, USA.|Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Brinkley-Rubinstein
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Turner
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Bebawy
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sterling
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Hulgan
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001071:Appointments and Schedules; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology*; D000074609:Marijuana Use / Q000453:epidemiology*; D008875:Middle Aged; D000067455:No-Show Patients / Q000706:statistics & numerical data*; D016017:Odds Ratio; D012189:Retrospective Studies
keywords: Adherence; Cannabis; Drug users; HIV; No-show patients