Type and Pattern of Illicit Drug Use and Access to Health Care Services for HIV-Infected People

Abstract

Approximately 28% of HIV-infected people in treatment in the United States report using illicit drugs. Illicit drug users have poorer course of HIV disease than non-drug users, which is thought to be due to their irregular use of HIV medical services. We examined associations between type (cocaine versus opioids) and pattern of drug use (drug use at baseline, 6-month follow-up, both periods, and nonuse) and health care utilization for a large sample of HIV-infected individuals drawn from a multisite project that evaluated the impact of medical outreach interventions for populations at risk of poor retention in HIV care. Across all types and patterns of drug use, drug users were more likely to have suboptimal ambulatory care, miss scheduled appointments, use the emergency department, have unmet support services needs, and were less likely to take antiretroviral medications. Additionally, while people who started using drugs during the follow-up period and consistently used drugs across both periods differed from nonusers on missed appointments (odds ratio [OR] = 2.20 for starters versus nonusers, OR = 2.92 for consistent users versus nonusers), emergency department use (OR = 4.93 for starters versus nonusers, OR = 2.24 for consistent users versus nonusers), and antiretroviral medication use at follow-up (OR = 0.23 starters versus nonusers, OR = 0.19 for consistent users versus nonusers), those who stopped using drugs after the baseline period did not differ from nonusers. We conclude that health care utilization is poorer for people who use illicit drugs than those who do not, and stopping drug use may facilitate improvements in health care utilization and HIV outcomes for this population.

Patient Perspectives of an Integrated Program of Medical Care and Substance Use Treatment

“…17 For example, in persons with HIV, substance use disorders are barriers that significantly decrease adherence to medical care, [18][19][20][21] whereas treatment, specifically agonist medication for opioid dependence, results in increased adherence in people with HIV. 22,23 Patients with co-occurring substance use and HIV use higher levels of emergency room and inpatient services and have longer lengths of inpatient stays than other HIV-infected persons, 24,25 although opioid agonist treatment is associated with reduced acute care utilization.…”

“…34 Subjects in the sample who used drugs were less likely than non-users to have received optimal levels of HIV primary care and more likely to use emergency care. 35 When this population was compared with patients from the HIV Cost and Services Utilization Study (HCSUS), a national sample of HIV-infected persons, they were found to be significantly more likely to be heavy alcohol users and significantly less likely to use ambulatory medical care services. 36 While they may obtain medical care via their use of inpatient and emergency care, PSUDs also often do not receive the addiction treatment services they need.…”

The impact of marijuana use on memory in HIV-infected patients: a comprehensive review of the HIV and marijuana literatures

“…Further, alcohol and other drug use is high among HIV-infected individuals, with the only national prevalence study of HIV-infected adults in the US reporting that 26% were using illicit drugs other than marijuana without meeting criteria for dependence, and another 13% met criteria for drug dependence (including marijuana) within the last 12 months [87]. In a more recent multisite study of nearly 1,000 HIV-infected individuals, 40% reported cocaine or heavy alcohol use and 25% reported use of two or more illicit drugs (excluding alcohol or marijuana) in the past year [88]. Some studies in this review sought to account for these confounds by reporting mental health diagnoses or attempting to exclude individuals currently using other drugs, and this matching is important when making group comparisons.…”

Prevention counseling for HIV-infected persons: What every clinician needs to know

“…About 28% of all HIV-positive US patients in treatment report using illicit drugs [43]. This proportion may be higher among those who are not in care [44]. Using a structured clinical interview, 50% of patients in the past year and 33% in the past month reported a psychiatric comorbidity [45].…”

“…Using a structured clinical interview, 50% of patients in the past year and 33% in the past month reported a psychiatric comorbidity [45]. Psychiatric comorbidity in PLWHA was shown to increase sexual risk-taking, substance abuse, poor medication adherence, relational abuse, and other maladaptive behaviors [43,44,46,47]. Poorer immune and metabolic functioning was also attributed to substance abuse among PLWHA [44,45].…”