Among patients with unhealthy alcohol use, those with HIV are less likely than those without to receive evidence-based alcohol-related care: A national VA study.
Alcohol use has important adverse effects on people living with HIV (PLWH). This study of patients with recognized unhealthy alcohol use estimated and compared rates of alcohol-related care received by PLWH and HIV- patients.



Outpatients from the Veterans Health Administration who had one or more positive screen(s) for unhealthy alcohol use (AUDIT-C≥5) documented in their medical records 10/2009-5/2013 were eligible. Primary and secondary outcomes were brief intervention documented ≤14days after a positive alcohol screen, and a composite measure of any alcohol-related care (brief intervention, specialty addictions treatment or pharmacotherapy documented ≤365 days), respectively. Unadjusted and adjusted regression analyses compared alcohol-related care outcomes in PLWH and HIV- patients.



The sample included 830,825 outpatients (3,514 PLWH), reflecting 1,172,606 positive screens (1-5 per patient). For PLWH, 57.0% (95% confidence interval 55.4-58.5%) of positive screens were followed by brief intervention, compared to 73.8% (73.7-73.9%) for HIV- patients [relative rate: 0.77 (0.75-0.79), p<0.001]. After adjustment, comparable proportions were 61.0% (59.3-62.6%) for PLWH and 73.7% (73.6-73.8%) for HIV- patients [adjusted RR=0.83 (0.80-0.85); p<0.001]. Secondary outcome results were similar: for PLWH and HIV- patients, 67.1% (65.7-68.6%) and 77.7% (95% CI 77.7-77.8%) of positive screens, respectively, were followed by any alcohol-related care after adjustment [adjusted RR=0.86 (0.85-0.88), p<0.001].



In this large national sample of VA outpatients with unhealthy alcohol use, PLWH were less likely to receive alcohol-related care than HIV- patients. Special efforts may be needed to ensure alcohol-related care reaches PLWH.
Health Services Research and Development (HSR and D) Veterans Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care(COIN) Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States. Electronic address: emily.williams3@va.gov.
Emily C
EC
Williams
Health Services Research and Development (HSR and D) Veterans Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care(COIN) Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
Gwen T
GT
Lapham
Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States; Department of Biostatistics, University of Washington, Seattle, WA, United States.
Susan M
SM
Shortreed
Health Services Research and Development (HSR and D) Veterans Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care(COIN) Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Kidney Health Research Collaborative, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, CA, United States.
Anna D
AD
Rubinsky
Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
Jennifer F
JF
Bobb
Health Services Research and Development (HSR and D) Veterans Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care(COIN) Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States.
Kara M
KM
Bensley
Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, CA, United States.
Sheryl L
SL
Catz
Department of Health Services, University of Washington, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
Julie E
JE
Richards
Health Services Research and Development (HSR and D) Veterans Affairs (VA) Puget Sound Health Care System, Center of Innovation for Veteran-Centered Value-Driven Care(COIN) Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, United States; Center of Excellence in Substance Abuse Treatment and Education (CESATE) Veterans Affairs (VA) Puget Sound Health Care System - Seattle Division, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States; Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
Katharine A
KA
Bradley
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications / Q000628:therapy*; D055317:Evidence-Based Practice; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D055815:Young Adult
Alcohol; Alcohol use disorders; Brief intervention; Disparities; HIV