HIV screening among substance-abusing veterans in care

Received 23 September 2008; received in revised form 3 February 2009; accepted 2 March 2009. published online 06 April 2009.

Abstract

Calls for screening for HIV infection among individuals with substance use disorders, including alcohol use, are increasing. We investigated HIV screening and its predictors in the Veterans Health Administration (VA) system among such individuals in care. Our primary outcome was retrospective evidence of screening for HIV infection, adjusting for patient demographics and important comorbid disease. Of the 371,749 sample patients with histories of substance use disorders using VA services, 20% had evidence of HIV screening. Screening was lowest among those with alcohol use disorders alone (11%) and highest among those treated in substance use programs (28%) or receiving inpatient care (28%). The findings suggest a low recognition of substance use disorders (especially alcohol use) as risk factors for HIV. Quality improvement initiatives to increase risk factor recognition and screening among patients with substance use disorders will yield benefits in the fight against HIV.

Keywords: HIV screening, HIV testing, HIV risk, Alcohol use disorders, Substance use disorders

a VA HSR&D Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA

b Brigham and Women's Hospitalist Service, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA

c Center for Organization, Leadership and Management Research, VA Boston Healthcare System, Boston, MA 02130, USA

d Department of Health Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA

e Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Sepulveda, CA 91343, USA

f Infectious Diseases Section and Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA

g The David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA

h HIV Hepatitis Quality Enhancement Research Initiative, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA

i Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA

j Section of General Internal Medicine, Boston University School of Medicine, Boston, MA 02118, USA

Corresponding author. Brigham and Women's Hospitalist Service, 75 Francis St, PBB-B-428, Boston, MA 02115, USA. Tel.: +1 617 732 6649; fax: +1 617 278 6906.

PII: S0740-5472(09)00031-2

doi:10.1016/j.jsat.2009.03.003

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