Decreased Quality of Care for HIV-Infected People Who Use Alcohol and Other Drugs

Combined antiretroviral treatment has had a significant impact on survival of HIV-infected individuals. With HIV now considered a chronic medical condition, providers must consider certain quality indicators (QIs) when caring for HIV-infected patients. Researchers examined the association between self-reported past-year unhealthy alcohol use* and illicit drug use and quality of HIV care among HIV-infected Veterans Affairs (VA) patients based on 9 QIs. The sample consisted of 3410 HIV-infected patients enrolled in the Veterans Aging Cohort Study (mean age, 49 years; 97% male).

• Twenty-six percent of the sample had unhealthy alcohol use, 29% had illicit drug use, and 12% had both.

• Patients infected with HIV received 82% (standard deviation [SD], 18.9) of the 9 QIs.

• Receipt of QI was lower among patients with unhealthy alcohol use versus those without (59% versus 70%) and among patients with illicit drug use versus those without (58% versus 71%). Unhealthy alcohol and illicit drug use were inversely associated with receipt of QI after adjusting for age, gender, race, history of homelessness, diabetes, depressed mood, and study site.

Comments:

Overall, quality of HIV care in this sample of HIV-infected veterans was high, but it was lower among patients reporting unhealthy alcohol and illicit drug use. Although generalizabilty may be limited as the sample was primarily men and QIs delivered at non-VA sites are not reflected, this work suggests targeted interventions to improve quality of care for HIV-infected substance users are needed.

Jeanette M. Tetrault, MD

Reference:

Korthuis PT, Fiellin DA, McGinnis KA, et al. Unhealthy alcohol and illicit drug use are associated with decreased quality of HIV care. J Acquir Immune Defic Syndr. 2012;61(2):171–178.