TY - JOUR
T1 - Among patients with unhealthy alcohol use, those with HIV are less likely than those without to receive evidence-based alcohol-related care
T2 - A national VA study
AU - Williams, Emily C.
AU - Lapham, Gwen T.
AU - Shortreed, Susan M.
AU - Rubinsky, Anna D.
AU - Bobb, Jennifer F.
AU - Bensley, Kara M.
AU - Catz, Sheryl L
AU - Richards, Julie E.
AU - Bradley, Katharine A.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Background 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. Methods 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 ≤14 days 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. Results 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]. Conclusions 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.
AB - Background 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. Methods 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 ≤14 days 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. Results 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]. Conclusions 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.
KW - Alcohol
KW - Alcohol use disorders
KW - Brief intervention
KW - Disparities
KW - HIV
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U2 - 10.1016/j.drugalcdep.2017.01.018
DO - 10.1016/j.drugalcdep.2017.01.018
M3 - Article
C2 - 28324813
AN - SCOPUS:85015375885
VL - 174
SP - 113
EP - 120
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
SN - 0376-8716
ER -