Michael J Silverberg1, Tory Levine-Hall1, Nicole Hood1, Alexandra N Anderson1, Stacey E Alexeeff1, Jennifer O Lam1, Sally B Slome2, Jason A Flamm3, Charles Bradley Hare4, Thekla Ross1, Amy C Justice5,6, Jonathan A C Sterne7,8, Andrew E Williams9, Kendall J Bryant10, Constance M Weisner1, Michael A Horberg11, Stacy A Sterling1, Derek D Satre1,12. 1. From the, Division of Research, (MJS, TL-H, NH, ANA, SEA, JOL, TR, CMW, SAS, DDS), Kaiser Permanente Northern California (KPNC), Oakland, California. 2. Oakland Medical Center, (SBS), KPNC, Oakland, California. 3. Sacramento Medical Center, (JAF), KPNC, Sacramento, California. 4. San Francisco Medical Center, (CBH), KPNC, San Francisco, California. 5. Yale School of Medicine, (AJ), Yale University, West Haven, Connecticut. 6. VA Connecticut Healthcare System, (AJ), West Haven, Connecticut. 7. Department of Population Health Sciences, (JACS), Bristol Medical School, University of Bristol, Bristol, UK. 8. Health Data Research UK South West, Bristol, UK. 9. Tufts Medical Center, (AEW), Boston, Massachusetts. 10. National Institute on Alcohol Abuse and Alcoholism, (KJB), National Institutes of Health, Bethesda, Maryland. 11. Mid-Atlantic Permanente Research Institute, (MAH), Kaiser Permanente Mid-Atlantic States, Rockville, Maryland. 12. Department of Psychiatry and Behavioral Sciences, (DDS), Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California.
Abstract
BACKGROUND: Unhealthy alcohol use among persons living with HIV (PLWH) is linked to significant morbidity, and use of alcohol services may differ by HIV status. Our objective was to compare unhealthy alcohol use screening and treatment by HIV status in primary care. METHODS: Cohort study of adult (≥18 years) PLWH and HIV-uninfected participants frequency matched 20:1 to PLWH by age, sex, and race/ethnicity who were enrolled in a large integrated healthcare system in the United States, with information ascertained from an electronic health record. Outcomes included unhealthy alcohol screening, prevalence, provider-delivered brief interventions, and addiction specialty care visits. Other predictors included age, sex, race/ethnicity, neighborhood deprivation index, depression, smoking, substance use disorders, Charlson comorbidity index, prior outpatient visits, insurance type, and medical facility. Cox proportional hazards models were used to compute hazard ratios (HR) for the outcomes of time to unhealthy alcohol use screening and time to first addiction specialty visit. Poisson regression with robust standard errors was used to compute prevalence ratios (PR) for other outcomes. RESULTS: 11,235 PLWH and 227,320 HIV-uninfected participants were included. By 4.5 years after baseline, most participants were screened for unhealthy alcohol use (85% of PLWH and 93% of HIV-uninfected), but with a lower rate among PLWH (adjusted HR 0.84, 95% CI 0.82 to 0.85). PLWH were less likely, compared with HIV-uninfected participants, to report unhealthy drinking among those screened (adjusted PR 0.74, 95% CI 0.69 to 0.79), and among those who screened positive, less likely to receive brief interventions (adjusted PR 0.82, 95% CI 0.75 to 0.90), but more likely (adjusted HR 1.7, 95% CI 1.2 to 2.4) to have an addiction specialty visit within 1 year. CONCLUSIONS: Unhealthy alcohol use was lower in PLWH, but the treatment approach by HIV status differed. PLWH reporting unhealthy alcohol use received less brief interventions and more addiction specialty care than HIV-uninfected participants.
BACKGROUND: Unhealthy alcohol use among persons living with HIV (PLWH) is linked to significant morbidity, and use of alcohol services may differ by HIV status. Our objective was to compare unhealthy alcohol use screening and treatment by HIV status in primary care. METHODS: Cohort study of adult (≥18 years) PLWH and HIV-uninfected participants frequency matched 20:1 to PLWH by age, sex, and race/ethnicity who were enrolled in a large integrated healthcare system in the United States, with information ascertained from an electronic health record. Outcomes included unhealthy alcohol screening, prevalence, provider-delivered brief interventions, and addiction specialty care visits. Other predictors included age, sex, race/ethnicity, neighborhood deprivation index, depression, smoking, substance use disorders, Charlson comorbidity index, prior outpatient visits, insurance type, and medical facility. Cox proportional hazards models were used to compute hazard ratios (HR) for the outcomes of time to unhealthy alcohol use screening and time to first addiction specialty visit. Poisson regression with robust standard errors was used to compute prevalence ratios (PR) for other outcomes. RESULTS: 11,235 PLWH and 227,320 HIV-uninfected participants were included. By 4.5 years after baseline, most participants were screened for unhealthy alcohol use (85% of PLWH and 93% of HIV-uninfected), but with a lower rate among PLWH (adjusted HR 0.84, 95% CI 0.82 to 0.85). PLWH were less likely, compared with HIV-uninfected participants, to report unhealthy drinking among those screened (adjusted PR 0.74, 95% CI 0.69 to 0.79), and among those who screened positive, less likely to receive brief interventions (adjusted PR 0.82, 95% CI 0.75 to 0.90), but more likely (adjusted HR 1.7, 95% CI 1.2 to 2.4) to have an addiction specialty visit within 1 year. CONCLUSIONS: Unhealthy alcohol use was lower in PLWH, but the treatment approach by HIV status differed. PLWH reporting unhealthy alcohol use received less brief interventions and more addiction specialty care than HIV-uninfected participants.
Authors: Emily C Williams; Kathleen A McGinnis; Janet P Tate; Theresa E Matson; Anna D Rubinsky; Jennifer F Bobb; Gwen T Lapham; E Jennifer Edelman; Sheryl L Catz; Derek D Satre; Kendall J Bryant; Brandon D L Marshall; Kevin L Kraemer; Kara M Bensley; Julie E Richards; Melissa Skanderson; Amy C Justice; David A Fiellin; Katharine A Bradley Journal: J Acquir Immune Defic Syndr Date: 2019-08-01 Impact factor: 3.731
Authors: Derek D Satre; Varada Sarovar; Wendy Leyden; Charles B Hare; Sheryl L Catz; Kendall J Bryant; Emily C Williams; J Carlo Hojilla; Michael A Horberg; Michael J Silverberg Journal: AIDS Behav Date: 2020-06
Authors: Derek D Satre; Amy S Leibowitz; Wendy Leyden; Sheryl L Catz; C Bradley Hare; Hannah Jang; Jennifer O Lam; Kendall J Bryant; Constance M Weisner; Stacy A Sterling; Michael Horberg; Paul Volberding; Michael J Silverberg Journal: J Gen Intern Med Date: 2019-06-11 Impact factor: 5.128
Authors: Heidi M Crane; Mary E McCaul; Geetanjali Chander; Heidi Hutton; Robin M Nance; Joseph A C Delaney; Joseph O Merrill; Bryan Lau; Kenneth H Mayer; Michael J Mugavero; Matthew Mimiaga; James H Willig; Greer A Burkholder; Daniel R Drozd; Rob J Fredericksen; Karen Cropsey; Richard D Moore; Jane M Simoni; W Christopher Mathews; Joseph J Eron; Sonia Napravnik; Katerina Christopoulos; Elvin Geng; Michael S Saag; Mari M Kitahata Journal: AIDS Behav Date: 2017-07
Authors: Emily C Williams; Gwen T Lapham; Susan M Shortreed; Anna D Rubinsky; Jennifer F Bobb; Kara M Bensley; Sheryl L Catz; Julie E Richards; Katharine A Bradley Journal: Drug Alcohol Depend Date: 2017-03-06 Impact factor: 4.492
Authors: Jeffrey H Samet; Debbie M Cheng; Howard Libman; David P Nunes; Julie K Alperen; Richard Saitz Journal: J Acquir Immune Defic Syndr Date: 2007-10-01 Impact factor: 3.731
Authors: Pamela J Stoddard; Barbara A Laraia; E Margaret Warton; Howard H Moffet; Nancy E Adler; Dean Schillinger; Andrew J Karter Journal: Diabetes Care Date: 2012-12-28 Impact factor: 19.112
Authors: Thibaut Davy-Mendez; Varada Sarovar; Tory Levine-Hall; Alexandra N Lea; Stacy A Sterling; Felicia W Chi; Vanessa A Palzes; Kendall J Bryant; Constance M Weisner; Michael J Silverberg; Derek D Satre Journal: Drug Alcohol Depend Date: 2021-09-28 Impact factor: 4.492
Authors: Yun Lu; Felicia W Chi; Sujaya Parthasarathy; Vanessa A Palzes; Andrea H Kline-Simon; Verena E Metz; Constance Weisner; Derek D Satre; Cynthia I Campbell; Joseph Elson; Thekla B Ross; Sameer V Awsare; Stacy A Sterling Journal: Alcohol Clin Exp Res Date: 2021-09-05 Impact factor: 3.928
Authors: Thibaut Davy-Mendez; Varada Sarovar; Tory Levine-Hall; Alexandra N Lea; Stacy A Sterling; Felicia W Chi; Vanessa A Palzes; Mitchell N Luu; Jason A Flamm; C Bradley Hare; Emily C Williams; Kendall J Bryant; Constance M Weisner; Michael J Silverberg; Derek D Satre Journal: AIDS Behav Date: 2022-09-28
Authors: Derek D Satre; Tory Levine-Hall; Stacy A Sterling; Kelly C Young-Wolff; Jennifer O Lam; Stacey Alexeeff; J Carlo Hojilla; Andrew Williams; Amy C Justice; Jonathan Sterne; Matthias Cavassini; Kendall J Bryant; Emily C Williams; Michael A Horberg; Paul Volberding; Constance Weisner; Michael J Silverberg Journal: Drug Alcohol Depend Date: 2021-01-08 Impact factor: 4.492