Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV.
J Subst Abuse Treat
; 109: 14-22, 2020 02.
Article
in En
| MEDLINE
| ID: mdl-31856946
ABSTRACT
INTRODUCTION:
Infrequent use of and poor retention on evidence-based medications for alcohol use disorder (MAUD) represent a treatment gap, particularly among people living with HIV (PLWH). We examined predictors of MAUD initiation and retention across HIV status.METHODS:
From Veterans Aging Cohort Study (VACS) data, we identified new alcohol use disorder (AUD) diagnoses from 1998 to 2015 among 163,339 individuals (50,826 PLWH and 112,573 uninfected, matched by age, sex, and facility). MAUD initiation was defined as a prescription fill for naltrexone, acamprosate or disulfiram within 30â¯days of a new diagnosis. Among those who initiated, retention was defined as filling medication for ≥80% of days over the following six months. We used multivariable logistic regression to assess patient- and facility-level predictors of AUD medication initiation across HIV status.RESULTS:
Among 10,603 PLWH and 24,424 uninfected individuals with at least one AUD episode, 359 (1.0%) initiated MAUD and 49 (0.14%) were retained. The prevalence of initiation was lower among PLWH than those without HIV (adjusted odds ratio [AOR] 0.66, 95% confidence interval [CI] 0.51-0.85). Older age (for PLWH AOR 0.78, 95% CI 0.61-0.99; for uninfected AOR 0.70, 95% CI 0.61-0.80) and black race (for PLWH AOR 0.63, 95% CI 0.0.49-0.1.00; for uninfected AOR 0.63, 95% CI 0.48-0.83), were associated with decreased odds of initiation for both groups. The low frequency of retention precluded multivariable analyses for retention.CONCLUSIONS:
For PLWH and uninfected individuals, targeted implementation strategies to expand MAUD are needed, particularly for specific subpopulations (e.g. black PLWH).
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Veterans
/
HIV Infections
/
Alcohol Deterrents
/
Alcoholism
/
Acamprosate
/
Naltrexone
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Subst Abuse Treat
Journal subject:
TRANSTORNOS RELACIONADOS COM SUBSTANCIAS
Year:
2020
Document type:
Article