Lower Quality of HIV Care in Drug, Alcohol Users: US Veterans Study
US HIV-positive veterans in the Veterans Aging Cohort Study (VACS) who used illicit drugs or abused alcohol were more likely to receive worse care than veterans who did not abuse drugs or alcohol, according to results of a large retrospective study.
Substance-abusing people with HIV infection have worse health outcomes, possibly because they receive less consistent care than others with HIV. To determine the impact of substance abuse on quality of care in US veterans, VACS researchers collected data on 9 quality-of-care indicators (QIs) from medical records. They relied on self-report to determine which veterans had unhealthy alcohol use (AUDIC-C score at or above 4) or used illicit drugs (stimulant, opioid, or injection drug use in past year).
Of the 3410 study participants, 97.4% were men and 67% black. Their age averaged 49.1 years (standard deviation 8.8). About one quarter of these veterans reported either unhealthy alcohol use (25.8%) or illicit drug use (22%). Overall QI rate stood at 81.5% (standard deviation 18.9).
Veterans with unhealthy alcohol use had a lower average QI score than veterans who did not abuse alcohol (59.3% versus 70.0%, P < 0.001). Illicit drug users also had a significantly lower average QI (57.8% versus 70.7%, P < 0.001).
A multivariate model confirmed significant inverse correlations between unhealthy alcohol use and percentage of QIs received (adjusted β −2.74, 95% confidence interval −4.23 to −1.25) and between illicit drug use and QI percentage (adjusted β −3.51, 95% CI −4.99 to −2.02).
“Although the overall quality of care for these HIV-infected Veteran patients was high,” the authors conclude, “gaps persist for those with unhealthy alcohol and illicit drug use.” They suggest “interventions that address substance use in HIV-infected patients may improve the quality of care received.”
Source: P. Todd Korthuis, David A. Fiellin, Kathleen A. McGinnis, Melissa Skanderson, Amy C. Justice, Adam J. Gordon, Donna Almario Doebler, Steven M. Asch, Lynn E. Fiellin, Kendall Bryant, Cynthia L. Gibert, Stephen Crystal, Matthew Bidwell Goetz, David Rimland, Maria C. Rodriguez-Barradas, Kevin L. Kraemer. Unhealthy alcohol and illicit drug use are associated with decreased quality of HIV care. JAIDS. 2012; 61: 171-178.
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Written by Mark Mascolini on behalf of the International AIDS Society