Predictors for Linkage to Care Among Persons Living with HIV and Co-Occurring Substance Use Disorder Open Access

Summers, Nathan (Spring 2019)

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Background: Persons living with HIV (PLWH) with substance use disorders (SUD) progress along the HIV care continuum at lower rates than those without. Project HOPE was a randomized controlled trial assessing patient navigation with/without contingency management among hospitalized PLWH with SUD on viral suppression at 12 months. The purpose of this secondary analysis was to determine factors affecting linkage to care at 6 months among PLWH with SUD.

Methods:  Project HOPE enrolled 801 participants from 11 hospitals in the United States from 2012 through 2014. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the estimated effect of socioeconomic factors, medical mistrust scores, and perceived discrimination within the healthcare setting on linkage to care at the 6-month follow-up assessment. These were then evaluated for effect modification on the intervention arms on linkage to care at 6 months. These factors were also evaluated for their effect on early linkage to care, within 30 days of enrollment, which was then evaluated for its effect on engagement in care.

Results: Participants who had not completed high school (aOR: 0.42; 95% CI: 0.26, 0.69) and those with severe food insecurity (aOR: 0.46; 95% CI: 0.25 to 0.83) were found to have lower odds of being linked to care at 6 months in the multivariable analysis. Participants with low education (OR: 0.67, 95% CI: 0.49 to 0.93), medical mistrust (OR: 0.59, 95% CI: 0.38 to 0.93), and eligibility due to drug use (OR: 0.69, 95% CI: 0.48 to 0.98) had lower odds of early linkage to care, within 30 days of enrollment. Individuals who linked to care early were much more likely to be engaged in care at 6 months than those who linked later (OR: 4.03, 95% CI: 2.75 to 5.91).

Conclusions: Addressing social determinants of health such as education, income, and medical mistrust is critical to correcting the disparity seen in HIV care outcomes among PLWH with SUD. Determining factors that alter the effect of patient navigators with or without financial incentives could help target such interventions and identify patients who would benefit most.

Table of Contents

1.     Introduction                                    Pages 1-2

2.     Background                                      Pages 3-6

3.     Methods                                            Pages 7-12

4.     Results                                               Pages 13-16

5.     Discussion                                        Pages 17-21

6.     References                                        Pages 22-29

7.     Tables/Figures                                  Pages 30-38

a.     Figure 1                                             Page 30

b.     Figure 2                                            Page 31

c.      Table 1                                             Page 32

d.     Table 2                                              Page 33

e.     Table 3                                             Page 34

f.       Table 4                                            Page 35-36

g.     Table 5                                            Page 37

h.     Table 6                                            Page 38

i.       Table 7                                           Page 39

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