| THE ROLE OF ALCOHOL/DRUG ABUSE AND TREATMENT IN APPOINTMENT ATTENDANCE AND VIROLOGIC RESPONSE AMONG HIV+ AFRICAN AMERICANS. Chanelle Howe*, Michael Mugavero, Stephen Cole, Sonia Napravnik, Jay Kaufman, Adaora Adimora, Joseph Eron, (Department of Epidemiology, Center for Population Health and Clinical Epidemiology, Brown University Program in Public Health, Providence RI USA) |
| Prior work showed that among HIV+ patients, missed clinic appointments partially explained why virologic failure (i.e., detectable plasma HIV RNA while on therapy) was more common among African Americans (AA) than Caucasians (Mugavero et al. JAIDS 2009,50:100-8). We estimated the effect of alcohol/drug abuse and treatment on attending scheduled appointments and virologic success among 539 AA patients with scheduled HIV primary care appointments in the UAB 1917 Clinic Cohort between 1/1/2007 and 8/1/2011 using modified Poisson regression models. Models were adjusted for age, first visit date, gender, an AIDS diagnosis, CD4 count, time on antiretroviral therapy, time since last attendance or success, appointment or RNA assessment number, education, insurance, as well as prison, long-term drug/alcohol abuse, and mental illness history. At the first clinic visit, the median (quartiles) age and CD4 count was 36 (28; 44) years and 337 (145; 543) cells/mm^3, respectively. During follow up, 32% of patients had abused or received treatment for alcohol/drugs in the prior year while half had attended at least 80% of appointments and achieved virologic success for at least 60% of RNA assessments. Compared to patients who abused without treatment, the adjusted risk ratio (RR) for attending scheduled appointments was 1.07 (95% confidence limits: 0.73, 1.58) among patients who did not abuse and were not in treatment, 1.08 (0.71, 1.63) among patients who did not abuse while in treatment, and 0.64 (0.49, 0.85) among patients who abused while in treatment. The corresponding adjusted RRs for virologic success were 1.25 (0.62, 2.49), 1.11 (0.50, 2.47), and 1.18 (0.77, 1.80). Among HIV+ AA UAB patients, alcohol/drug treatment among concurrent abusers may decrease attendance yet increase the likelihood of virologic success. Abuse appeared to decrease attendance overall, but decrease virologic success only among those not in treatment. However, RR estimates were imprecise. |