The relationship of smoking and unhealthy alcohol use to the HIV care continuum among people with HIV in an integrated health care system

Derek D Satre; Tory Levine-Hall; Stacey A Sterling; Kelly Young-Wolff; Jennifer O Lam; Stacey  Alexeeff; Carlo  Hojilla; Andrew Williams; Amy C Justice; Jonathan A C Sterne; Matthias  Cavassini; Kendall J Bryant; Emily C Williams; Michael A Horberg; Paul  Volberding; Constance Weisner; Michael J Silverberg

doi:10.1016/j.drugalcdep.2020.108481

The relationship of smoking and unhealthy alcohol use to the HIV care continuum among people with HIV in an integrated health care system

Derek D Satre^*, Tory Levine-Hall, Stacey A Sterling, Kelly Young-Wolff, Jennifer O Lam, Stacey Alexeeff, Carlo Hojilla, Andrew Williams, Amy C Justice, Jonathan A C Sterne, Matthias Cavassini, Kendall J Bryant, Emily C Williams, Michael A Horberg, Paul Volberding, Constance Weisner, Michael J Silverberg

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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Abstract

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 = 8958) 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.

Original language	English
Article number	108481
Number of pages	9
Journal	Drug and Alcohol Dependence
Volume	219
Early online date	8 Jan 2021
DOIs	https://doi.org/10.1016/j.drugalcdep.2020.108481
Publication status	Published - 1 Feb 2021

Bibliographical note

Funding Information:
Funding was provided by the National Institute on Alcohol Abuse and Alcoholism , U01AA026230 , K24AA025703 . The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication

Publisher Copyright:
© 2020 Elsevier B.V.

Keywords

smoking
alcohol
primary care
integrated health care
HIV care continuum
viral control

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Satre, D. D., Levine-Hall, T., Sterling, S. A., Young-Wolff, K., Lam, J. O., Alexeeff, S., Hojilla, C., Williams, A., Justice, A. C., Sterne, J. A. C., Cavassini, M., Bryant, K. J., Williams, E. C., Horberg, M. A., Volberding, P., Weisner, C., & Silverberg, M. J. (2021). The relationship of smoking and unhealthy alcohol use to the HIV care continuum among people with HIV in an integrated health care system. Drug and Alcohol Dependence, 219, [108481]. https://doi.org/10.1016/j.drugalcdep.2020.108481

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title = "The relationship of smoking and unhealthy alcohol use to the HIV care continuum among people with HIV in an integrated health care system",

abstract = "IntroductionSmoking tobacco and unhealthy alcohol use may negatively influence HIV care continuum outcomes but have not been examined in combination.MethodsParticipants 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.ResultsThe overall sample (N = 8958) 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).ConclusionsIn 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.",

keywords = "smoking, alcohol, primary care, integrated health care, HIV care continuum, viral control",

author = "Satre, {Derek D} and Tory Levine-Hall and Sterling, {Stacey A} and Kelly Young-Wolff and Lam, {Jennifer O} and Stacey Alexeeff and Carlo Hojilla and Andrew Williams and Justice, {Amy C} and Sterne, {Jonathan A C} and Matthias Cavassini and Bryant, {Kendall J} and Williams, {Emily C} and Horberg, {Michael A} and Paul Volberding and Constance Weisner and Silverberg, {Michael J}",

note = "Funding Information: Funding was provided by the National Institute on Alcohol Abuse and Alcoholism , U01AA026230 , K24AA025703 . The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication Publisher Copyright: {\textcopyright} 2020 Elsevier B.V.",

year = "2021",

month = feb,

day = "1",

doi = "10.1016/j.drugalcdep.2020.108481",

language = "English",

volume = "219",

journal = "Drug and Alcohol Dependence",

issn = "0376-8716",

publisher = "Elsevier Sequoia",

}

Satre, DD, Levine-Hall, T, Sterling, SA, Young-Wolff, K, Lam, JO, Alexeeff, S, Hojilla, C, Williams, A, Justice, AC, Sterne, JAC, Cavassini, M, Bryant, KJ, Williams, EC, Horberg, MA, Volberding, P, Weisner, C & Silverberg, MJ 2021, 'The relationship of smoking and unhealthy alcohol use to the HIV care continuum among people with HIV in an integrated health care system', Drug and Alcohol Dependence, vol. 219, 108481. https://doi.org/10.1016/j.drugalcdep.2020.108481

TY - JOUR

T1 - The relationship of smoking and unhealthy alcohol use to the HIV care continuum among people with HIV in an integrated health care system

AU - Satre, Derek D

AU - Levine-Hall, Tory

AU - Sterling, Stacey A

AU - Young-Wolff, Kelly

AU - Lam, Jennifer O

AU - Alexeeff, Stacey

AU - Hojilla, Carlo

AU - Williams, Andrew

AU - Justice, Amy C

AU - Sterne, Jonathan A C

AU - Cavassini, Matthias

AU - Bryant, Kendall J

AU - Williams, Emily C

AU - Horberg, Michael A

AU - Volberding, Paul

AU - Weisner, Constance

AU - Silverberg, Michael J

N1 - Funding Information: Funding was provided by the National Institute on Alcohol Abuse and Alcoholism , U01AA026230 , K24AA025703 . The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication Publisher Copyright: © 2020 Elsevier B.V.

PY - 2021/2/1

Y1 - 2021/2/1

N2 - IntroductionSmoking tobacco and unhealthy alcohol use may negatively influence HIV care continuum outcomes but have not been examined in combination.MethodsParticipants 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.ResultsThe overall sample (N = 8958) 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).ConclusionsIn 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.

AB - IntroductionSmoking tobacco and unhealthy alcohol use may negatively influence HIV care continuum outcomes but have not been examined in combination.MethodsParticipants 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.ResultsThe overall sample (N = 8958) 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).ConclusionsIn 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.

KW - smoking

KW - alcohol

KW - primary care

KW - integrated health care

KW - HIV care continuum

KW - viral control

U2 - 10.1016/j.drugalcdep.2020.108481

DO - 10.1016/j.drugalcdep.2020.108481

M3 - Article (Academic Journal)

C2 - 33429295

SN - 0376-8716

VL - 219

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

M1 - 108481

ER -

The relationship of smoking and unhealthy alcohol use to the HIV care continuum among people with HIV in an integrated health care system

Abstract

Bibliographical note

Keywords

UN SDGs

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