Gender and alcohol use: Influences on HIV care continuum in a national cohort of patients with HIV

Theresa E. Matson, Kathleen A. McGinnis, Anna D. Rubinsky, Madeline C. Frost, Maggie Czarnogorski, Kendall J. Bryant, E. Jennifer Edelman, Derek D. Satre, Sheryl L Catz, Kara M. Bensley, David A. Fiellin, Amy C. Justice, Emily C. Williams

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: To investigate whether gender is associated with three recommended stages of the HIV care continuum and whether gender modifies known associations between level of alcohol use and HIV care among US veterans. Design: Retrospective cohort. Methods: Veterans Aging Cohort Study data were used to identify Veterans Health Administration (VA) patients with HIV and AUDIT-C alcohol screening from 1 February 2008 to 30 September 2014. Modified Poisson regression models estimated the relative risk and predicted prevalences of engagement in HIV care (documented CD4 þ cells/ml or viral load copies/ml lab values), ART treatment (at least one prescription), and viral suppression (HIV RNA <500 copies/ml) in the year following AUDIT-C (1) for women compared to men, and (2) for each level of alcohol use compared to nondrinking among women and among men. A multiplicative interaction between gender and alcohol use was tested. Results: Among 33 224 patients, women (n ¼ 971) were less likely than men (n ¼ 32 253) to receive HIV care (P values <0.001). Respective predicted prevalences for women and men were 71.9% (95% CI 69.1 - 74.7%) and 77.9% (77.5 - 78.4%) for engagement, 60.0% (57.0 - 73.14%) and 73.8% (73.4 - 74.3%) for ART treatment, and 46.4% (43.3 - 49.6%) and 55.8% (55.3 - 56.3%) for viral suppression. Although the interaction between gender and alcohol use was not statistically significant, stratified analyses suggested worse outcomes for women than men at higher levels of alcohol use. Conclusion: In this large national cohort, women were less likely than men to be engaged in HIV medical care, prescribed ART, and virally suppressed. Interventions to improve HIV care for women are needed at all levels of alcohol use.

Original languageEnglish (US)
Pages (from-to)2247-2253
Number of pages7
JournalAIDS
Volume32
Issue number15
DOIs
StatePublished - Jan 1 2018

Fingerprint

Continuity of Patient Care
Alcohols
HIV
Veterans
Veterans Health
United States Department of Veterans Affairs
Viral Load
Prescriptions
Cohort Studies
RNA
Therapeutics

Keywords

  • Alcohol drinking
  • Continuity of patient care
  • HIV
  • Social determinants of health
  • Veterans
  • Viral load
  • Women

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Matson, T. E., McGinnis, K. A., Rubinsky, A. D., Frost, M. C., Czarnogorski, M., Bryant, K. J., ... Williams, E. C. (2018). Gender and alcohol use: Influences on HIV care continuum in a national cohort of patients with HIV. AIDS, 32(15), 2247-2253. https://doi.org/10.1097/QAD.0000000000001946

Gender and alcohol use : Influences on HIV care continuum in a national cohort of patients with HIV. / Matson, Theresa E.; McGinnis, Kathleen A.; Rubinsky, Anna D.; Frost, Madeline C.; Czarnogorski, Maggie; Bryant, Kendall J.; Jennifer Edelman, E.; Satre, Derek D.; Catz, Sheryl L; Bensley, Kara M.; Fiellin, David A.; Justice, Amy C.; Williams, Emily C.

In: AIDS, Vol. 32, No. 15, 01.01.2018, p. 2247-2253.

Research output: Contribution to journalArticle

Matson, TE, McGinnis, KA, Rubinsky, AD, Frost, MC, Czarnogorski, M, Bryant, KJ, Jennifer Edelman, E, Satre, DD, Catz, SL, Bensley, KM, Fiellin, DA, Justice, AC & Williams, EC 2018, 'Gender and alcohol use: Influences on HIV care continuum in a national cohort of patients with HIV', AIDS, vol. 32, no. 15, pp. 2247-2253. https://doi.org/10.1097/QAD.0000000000001946
Matson TE, McGinnis KA, Rubinsky AD, Frost MC, Czarnogorski M, Bryant KJ et al. Gender and alcohol use: Influences on HIV care continuum in a national cohort of patients with HIV. AIDS. 2018 Jan 1;32(15):2247-2253. https://doi.org/10.1097/QAD.0000000000001946
Matson, Theresa E. ; McGinnis, Kathleen A. ; Rubinsky, Anna D. ; Frost, Madeline C. ; Czarnogorski, Maggie ; Bryant, Kendall J. ; Jennifer Edelman, E. ; Satre, Derek D. ; Catz, Sheryl L ; Bensley, Kara M. ; Fiellin, David A. ; Justice, Amy C. ; Williams, Emily C. / Gender and alcohol use : Influences on HIV care continuum in a national cohort of patients with HIV. In: AIDS. 2018 ; Vol. 32, No. 15. pp. 2247-2253.
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abstract = "Objectives: To investigate whether gender is associated with three recommended stages of the HIV care continuum and whether gender modifies known associations between level of alcohol use and HIV care among US veterans. Design: Retrospective cohort. Methods: Veterans Aging Cohort Study data were used to identify Veterans Health Administration (VA) patients with HIV and AUDIT-C alcohol screening from 1 February 2008 to 30 September 2014. Modified Poisson regression models estimated the relative risk and predicted prevalences of engagement in HIV care (documented CD4 {\th} cells/ml or viral load copies/ml lab values), ART treatment (at least one prescription), and viral suppression (HIV RNA <500 copies/ml) in the year following AUDIT-C (1) for women compared to men, and (2) for each level of alcohol use compared to nondrinking among women and among men. A multiplicative interaction between gender and alcohol use was tested. Results: Among 33 224 patients, women (n ¼ 971) were less likely than men (n ¼ 32 253) to receive HIV care (P values <0.001). Respective predicted prevalences for women and men were 71.9{\%} (95{\%} CI 69.1 - 74.7{\%}) and 77.9{\%} (77.5 - 78.4{\%}) for engagement, 60.0{\%} (57.0 - 73.14{\%}) and 73.8{\%} (73.4 - 74.3{\%}) for ART treatment, and 46.4{\%} (43.3 - 49.6{\%}) and 55.8{\%} (55.3 - 56.3{\%}) for viral suppression. Although the interaction between gender and alcohol use was not statistically significant, stratified analyses suggested worse outcomes for women than men at higher levels of alcohol use. Conclusion: In this large national cohort, women were less likely than men to be engaged in HIV medical care, prescribed ART, and virally suppressed. Interventions to improve HIV care for women are needed at all levels of alcohol use.",
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author = "Matson, {Theresa E.} and McGinnis, {Kathleen A.} and Rubinsky, {Anna D.} and Frost, {Madeline C.} and Maggie Czarnogorski and Bryant, {Kendall J.} and {Jennifer Edelman}, E. and Satre, {Derek D.} and Catz, {Sheryl L} and Bensley, {Kara M.} and Fiellin, {David A.} and Justice, {Amy C.} and Williams, {Emily C.}",
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T2 - Influences on HIV care continuum in a national cohort of patients with HIV

AU - Matson, Theresa E.

AU - McGinnis, Kathleen A.

AU - Rubinsky, Anna D.

AU - Frost, Madeline C.

AU - Czarnogorski, Maggie

AU - Bryant, Kendall J.

AU - Jennifer Edelman, E.

AU - Satre, Derek D.

AU - Catz, Sheryl L

AU - Bensley, Kara M.

AU - Fiellin, David A.

AU - Justice, Amy C.

AU - Williams, Emily C.

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N2 - Objectives: To investigate whether gender is associated with three recommended stages of the HIV care continuum and whether gender modifies known associations between level of alcohol use and HIV care among US veterans. Design: Retrospective cohort. Methods: Veterans Aging Cohort Study data were used to identify Veterans Health Administration (VA) patients with HIV and AUDIT-C alcohol screening from 1 February 2008 to 30 September 2014. Modified Poisson regression models estimated the relative risk and predicted prevalences of engagement in HIV care (documented CD4 þ cells/ml or viral load copies/ml lab values), ART treatment (at least one prescription), and viral suppression (HIV RNA <500 copies/ml) in the year following AUDIT-C (1) for women compared to men, and (2) for each level of alcohol use compared to nondrinking among women and among men. A multiplicative interaction between gender and alcohol use was tested. Results: Among 33 224 patients, women (n ¼ 971) were less likely than men (n ¼ 32 253) to receive HIV care (P values <0.001). Respective predicted prevalences for women and men were 71.9% (95% CI 69.1 - 74.7%) and 77.9% (77.5 - 78.4%) for engagement, 60.0% (57.0 - 73.14%) and 73.8% (73.4 - 74.3%) for ART treatment, and 46.4% (43.3 - 49.6%) and 55.8% (55.3 - 56.3%) for viral suppression. Although the interaction between gender and alcohol use was not statistically significant, stratified analyses suggested worse outcomes for women than men at higher levels of alcohol use. Conclusion: In this large national cohort, women were less likely than men to be engaged in HIV medical care, prescribed ART, and virally suppressed. Interventions to improve HIV care for women are needed at all levels of alcohol use.

AB - Objectives: To investigate whether gender is associated with three recommended stages of the HIV care continuum and whether gender modifies known associations between level of alcohol use and HIV care among US veterans. Design: Retrospective cohort. Methods: Veterans Aging Cohort Study data were used to identify Veterans Health Administration (VA) patients with HIV and AUDIT-C alcohol screening from 1 February 2008 to 30 September 2014. Modified Poisson regression models estimated the relative risk and predicted prevalences of engagement in HIV care (documented CD4 þ cells/ml or viral load copies/ml lab values), ART treatment (at least one prescription), and viral suppression (HIV RNA <500 copies/ml) in the year following AUDIT-C (1) for women compared to men, and (2) for each level of alcohol use compared to nondrinking among women and among men. A multiplicative interaction between gender and alcohol use was tested. Results: Among 33 224 patients, women (n ¼ 971) were less likely than men (n ¼ 32 253) to receive HIV care (P values <0.001). Respective predicted prevalences for women and men were 71.9% (95% CI 69.1 - 74.7%) and 77.9% (77.5 - 78.4%) for engagement, 60.0% (57.0 - 73.14%) and 73.8% (73.4 - 74.3%) for ART treatment, and 46.4% (43.3 - 49.6%) and 55.8% (55.3 - 56.3%) for viral suppression. Although the interaction between gender and alcohol use was not statistically significant, stratified analyses suggested worse outcomes for women than men at higher levels of alcohol use. Conclusion: In this large national cohort, women were less likely than men to be engaged in HIV medical care, prescribed ART, and virally suppressed. Interventions to improve HIV care for women are needed at all levels of alcohol use.

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KW - Social determinants of health

KW - Veterans

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