Health System‐Based Unhealthy Alcohol Use Screening and Treatment Comparing Demographically Matched Participants With and Without HIV

Background: Unhealthy alcohol use among persons living with HIV (PLWH) is linked to significantmorbidity, and use of alcohol services may differ by HIV status. Our objective was to compareunhealthy alcohol use screening and treatment by HIV status in primary care.

Methods: Cohort study of adult (≥18 years) PLWH and HIV-uninfected participants frequencymatched 20:1 to PLWH by age, sex, and race/ethnic ity who were enrolled in a large i ntegrated healthcaresystem in the United States, with information ascertained from an electronic health record. Outcomesincluded unhealthy alcohol screen ing, prevalence, provider-deli vered brief interventions, and addiction spe-cialty care visits. Other predictors included age, sex, race/ethnicity, neighborhood deprivation index, depres-sion, smoking, substance use disorders, Charlson comorbidity index, prior outpatient visits, insurance type,and medical facility. Cox proportional hazards models wer e used to compute hazard ratios (HR) for theoutcomes of time to unhealthy alcohol use screening and time to first addiction specialty visit. Poissonregression with robust standard errors was used to compute prevalence ratios (PR) for other outcomes.

Results: 11,235 PLWH and 227,320 HIV-uninfected participants were included. By 4.5 years afterbaseline, most participants were screened for unhealthy alcohol use (85% of PLWH and 93% of HIV-uninfected), but with a lower rate among PLWH (adjusted HR 0.84, 95% CI 0.82 to 0.85). PLWH wereless likely, compared with HIV-uninfected participants, to report unhealthy drinking among thosescreened (adjusted PR 0.74, 95% CI 0.69 to 0.79), and among those who screened positive, less likely toreceive brief interventions (adjusted PR 0.82, 95% CI 0.75 to 0.90), but more likely (adjusted HR 1.7,95% CI 1.2 to 2.4) to have an addiction specialty visit within 1 year.

Conclusions: Unhealthy alcohol use was lower in PLWH, but the treatment approach by HIV statusdiffered. PLWH reporting unhealthy alcohol use received less brief interventions and more addictionspecialty care than HIV-uninfected participants.