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      Influence of substance use disorders on two-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
          9712133
          21042
          AIDS Behav
          AIDS Behav
          AIDS and behavior
          1090-7165
          1573-3254
          13 June 2017
          March 2018
          01 March 2019
          : 22
          : 3
          : 742-751
          Affiliations
          [1 ]Alcohol & Drug Abuse Institute, University of Washington, Seattle WA
          [2 ]Division of Allergy and Infectious Disease, University of Washington, Seattle WA
          [3 ]Department of Medicine, University of North Carolina, Chapel Hill NC
          [4 ]Department of Epidemiology, University of North Carolina, Chapel Hill NC
          [5 ]School of Medicine, University of California, San Francisco CA
          [6 ]Department of Medicine, University of California, San Diego CA
          [7 ]School of Medicine, Harvard University, Boston MA
          [8 ]School of Public Health, Harvard University, Boston MA
          [9 ]Department of Medicine, Johns Hopkins University, Baltimore MD
          [10 ]Department of Epidemiology, Johns Hopkins University, Baltimore MD
          [11 ]Center for Global Health, Johns Hopkins University, Baltimore MD
          [12 ]Department of Medicine, University of Alabama, Birmingham AL
          [13 ]Department of Medicine, Case Western Reserve University, Cleveland OH
          [14 ]Psychiatry and Behavioral Sciences, University of Washington, Seattle WA
          Author notes
          Corresponding author: Bryan Hartzler, Ph.D., Alcohol & Drug Abuse Institute, University of Washington, Box 354805, 1107 NE 45 th Street, Suite 120, Seattle, WA 98105-4631, U.S.A., 206.543.8369, 206.543.5473 (fax), hartzb@ 123456u.washington.edu
          Article
          PMC5729068 PMC5729068 5729068 nihpa884635
          10.1007/s10461-017-1826-2
          5729068
          28612213
          fa0823af-acf6-4f79-981c-e01a970c2cd5
          History
          Categories
          Article

          substance use disorders,United States,care retention,HIV care settings

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