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      Influence of Substance Use Disorders on 2-Year HIV Care Retention in the United States.

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          Abstract

          Substance use disorders (SUDs) are thought to predict care discontinuity, though magnitude and substance-specific variance of effects are unclear. This report of analytic work undertaken with a multi-regional American cohort of 9153 care enrollees addresses these gaps. Care retention was computed from 24-month post-linkage clinic visit documentation, with SUD cases identified from patient-report screening instruments. Two generalized estimating equations tested binary and hierarchial SUD predictors of retention, and potential effect modification by patient age-group, sex, and care site. Findings demonstrate: (1) detrimental SUD effect, equivalent to a nine percentage-point decrease in retention, with independent effects of age-group and care site; (2) substance-specific effect of marijuana UD associated with lower retention; and (3) age-modification of each effect on care discontinuity, with SUDs serving as a risk factor among 18-29 year-olds and protective factor among 60+ year-olds. Collective findings document patient attributes as influences that place particular subgroups at-risk to discontinue care.

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          Author and article information

          Journal
          AIDS Behav
          AIDS and behavior
          Springer Science and Business Media LLC
          1573-3254
          1090-7165
          March 2018
          : 22
          : 3
          Affiliations
          [1 ] Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street Suite 120, Box 354805, Seattle, WA, 98105-4631, USA. hartzb@u.washington.edu.
          [2 ] Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA.
          [3 ] Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street Suite 120, Box 354805, Seattle, WA, 98105-4631, USA.
          [4 ] Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
          [5 ] Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
          [6 ] School of Medicine, University of California, San Francisco, CA, USA.
          [7 ] Department of Medicine, University of California, San Diego, CA, USA.
          [8 ] School of Medicine, Harvard University, Boston, MA, USA.
          [9 ] School of Public Health, Harvard University, Boston, MA, USA.
          [10 ] Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
          [11 ] Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
          [12 ] Center for Global Health, Johns Hopkins University, Baltimore, MD, USA.
          [13 ] Department of Medicine, University of Alabama, Birmingham, AL, USA.
          [14 ] Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
          [15 ] Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
          Article
          10.1007/s10461-017-1826-2 NIHMS884635
          10.1007/s10461-017-1826-2
          5729068
          28612213
          fa0823af-acf6-4f79-981c-e01a970c2cd5
          History

          Care retention,HIV care settings,Substance use disorders,United States

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