Health System‐Based Unhealthy Alcohol Use Screening and Treatment Comparing Demographically Matched Participants With and Without HIV

作者：Michael J. Silverberg, Tory Levine‐Hall, Nicole Hood, Alexandra Anderson, Stacey Alexeeff, Jennifer O. Lam, Sally Slome, Jason Flamm, C. Bradley Hare, Thekla B. Ross, Amy C. Justice, Jonathan A C Sterne, Andrew E. Williams, Kendall Bryant, Constance Weisner, Michael A. Horberg, Stacy Sterling, Derek D. Satre · 发表于：Alcoholism Clinical and Experimental Research · 年份：2020 · DOI：10.1111/acer.14481 · 被引用次数：16 · 研究领域：HIV/AIDS Research and Interventions、Substance Abuse Treatment and Outcomes、HIV-related health complications and treatments

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, co...