Initiation of Antiretroviral Therapy in the Hospital Is Associated With Linkage to Human Immunodeficiency Virus (HIV) Care for Persons Living With HIV and Substance Use Disorder.

BACKGROUND: Studies have demonstrated benefits of antiretroviral therapy (ART) initiation on the day of human immunodeficiency virus (HIV) testing or at first clinical visit. The hospital setting is understudied for immediate ART initiation. METHODS: CTN0049, a linkage-to-care randomized clinical trial, enrolled 801 persons living with HIV (PLWH) and substance use disorder (SUD) from 11 hospitals across the United States. This secondary analysis examined factors related to initiating (including reinitiating) ART in the hospital and its association with linkage to HIV care, frequency of outpatient care visits, retention, and viral suppression. RESULTS: Of 801 participants, 124 (15%) initiated ART in the hospital, with more than two-thirds of these participants (80/124) initiating ART for the first time. Time to first HIV care visit among those who initiated ART in the hospital and those who did not was 29 and 54 days, respectively (P = .0145). Hospital initiation of ART was associated with increased frequency of HIV outpatient care visits at 6 and 12 months. There was no association with ART initiation in the hospital and retention and viral suppression over a 12-month period. Participants recruited in Southern hospitals were less likely to initiate ART in the hospital (P < .001). CONCLUSIONS: Previous research demonstrated benefits of immediate ART initiation, yet this approach is not widely implemented. Research findings suggest that starting ART in the hospital is beneficial for increasing linkage to HIV care and frequency of visits for PLWH and SUD. Implementation research should address barriers to early ART initiation in the hospital.

Project CHOICE: Choosing healthy options in coping with emotions, an EMA/EMI plus in-person intervention for alcohol use.

Background: Emerging adulthood (18-25 years) represents a risky time for mental health and substance use. Emerging adults are particularly susceptible to problematic patterns of substance use, especially if they experience anxiety and/or depression and use substances as a way to cope with such issues. However, many mental health treatments do not address substance use. We developed an ecological momentary assessment and intervention (EMA/EMI) to specifically target the motive of drinking to cope with anxiety/depression. Methods: Project CHOICE was a 6-week intervention that paired in-person normative feedback with daily EMA and, if an individual reported negative affect and intent to drink, an EMI was immediately sent to their phone (a personally-chosen coping skill). We recruited n = 20 (55% female, mean age 21.74, 85% Caucasian and 75% non-Hispanic/Latino) individuals from a psychiatric partial hospitalization program for a 6-week open trial of the CHOICE intervention and re-assessed at the 6-week follow-up point. Results: Results indicated that drinking variables and coping motives were highly correlated at baseline. Days of drinking, alcohol-related problems, and coping motives significantly decreased over time following the intervention. Results indicated high levels of feasibility and acceptability. Conclusions: This open pilot represents a feasible, acceptable, and promising direction in delivering interventions in the moment when risk is highest, utilizing smartphone capabilities.