Daily Marijuana Use is Associated with Missed Clinic Appointments Among HIV-Infected Persons Engaged in HIV Care

Abstract

We assessed the association between marijuana use and retention in HIV care through a retrospective cohort study of patients engaged in care at a large HIV clinic in 2011 and 2012. Two different retention outcomes were assessed: not meeting the Institute of Medicine’s (IOM) retention definition (≥2 provider visits ≥90 days apart in a calendar year) and no-show visits. Any marijuana use and frequency of marijuana use were obtained from a substance use screening questionnaire administered at each clinic visit. Modified Poisson regression was used to estimate risk ratios and 95% confidence intervals for the association between marijuana use and retention outcomes. Marijuana use was reported by 17% of 1,791 patients and 21% were not retained (IOM definition). Marijuana use was not associated with the IOM retention outcome, but was associated with missing the next scheduled appointment. A non-linear dose- response was observed for frequency of marijuana use and missed visits, with daily users having the highest risk compared to non-users. Daily marijuana use had a negative impact on HIV clinic attendance. Further research is needed to elucidate the mechanisms by which marijuana use affects this outcome to inform targeted interventions.

Correlates of missed clinic visits among youth living with HIV

“…Two noteworthy etiological implications stemming from cyclically related pathways to optimal retention may underlie these associations. First, consistent with Social Action Theory and studies with adults (Kipp et al, 2017; Traeger et al, 2012), substance use and legal involvement could be present and even co-occurring in youth who are in stressful circumstances characterized by poverty and unsafe communities. Thus, these YLH may be already facing barriers to retention, and engaging in problem behavior, perhaps because of being exposed to such conditions, further limits their ability to attend to treatment demands.…”

“…YLH are particularly challenged with missing medical appointments (Horberg et al, 2013). Whereas research has paid attention to this behavior among adults (Horberg et al, 2013; Kipp et al, 2017; Traeger, O’Cleirigh, Skeer, Mayer, & Safren, 2012; Zinski et al, 2015), less is known about youth retention. Specifically, few studies have examined youths’ clinic attendance and its possible correlates (Harper et al, 2013; Kahana et al, 2015; Kahana et al, 2016).…”

“…At the same time, retention-related social and cognitive resources are associated with the degree to which patients can adhere to care within this context. Indeed, research with adults has found associations between missed clinic visits and patients’ sociodemographic characteristics (Horberg et al, 2013; Traeger et al, 2012), behavioral health problems (Kipp et al, 2017; Traeger et al, 2012), and social-cognitive resources (Traeger et al, 2012). When applied to retention, the Social Action Theory model also proposes a cyclical process; that is, patients who attend their appointments gain motivation and self-efficacy which further strengthens their ability to keep future appointments.…”

The Association Between Marijuana Use and HIV Continuum of Care Outcomes: a Systematic Review

“…One study investigated the impact of marijuana use on retention in HIV treatment engagement [27]. Participants consisted of 1549 HIV-infected individuals who were mostly White (51%) and male (75%), with a median age of 45 years.…”

“…Although there was no association between marijuana use and the IOM outcome, the findings indicated that any marijuana use was associated with a 37% chance of missing their next medical appointment (adjusted RR 1.37 [1.12, 1.69]) with the highest risk among those reporting marijuana use between seven-14 times per week (1.67 [1.30, 2.15]). Kipp and colleagues [27] concluded that daily marijuana use negatively impacts subsequent HIV medical appointment attendance.…”