Introduction: Smoking tobacco and unhealthy alcohol use may negatively influence HIV care continuum outcomes but have not been examined in combination.
Methods: Participants were people with HIV (PWH) in Kaiser Permanente Northern California. Predictors included smoking status and unhealthy alcohol use (exceeding daily and/or weekly limits) reported by patients during primary care screening (index date). Outcomes were based on not achieving the following steps in the care continuum: linkage to HIV care (≥1 visit within 90 days of newly identified HIV diagnosis), retention (2+ in-person visits, 60+ days apart) and HIV RNA control (<75 copies/mL). Adjusted odds ratios (ORs) were obtained from separate logistic regression models for each outcome associated with smoking and unhealthy alcohol use independently and combined.
Results: The overall sample (N=8,958) had a mean age of 48.0 years; was 91.3% male; 54.0% white, 17.6% Latino, 15.1% black, and 9.6% other race/ethnicity. Smoking was associated with higher odds of not being linked to HIV care (OR=1.60 [95% CI 1.03-2.48]), not retained (OR=1.30 [95% CI 1.13-1.50]), and HIV RNA not in control (OR=1.91 [95% CI 1.60-2.27]). Alcohol measures were not independently associated with outcomes. The combination of unhealthy alcohol use and smoking (versus neither) was associated with higher odds of not being linked to care (OR=2.83 [95% CI 1.40-5.71]), although the interaction did not reach significance (p=0.18).
Conclusions: In this large sample of PWH in an integrated health care system, smoking, both independently and in combination with unhealthy alcohol use, was associated with worse HIV care continuum outcomes.
- primary care
- integrated health care
- HIV care continuum
- viral control