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Alcohol screening less likely in blacks, people with AIDS, in big HIV group
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22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018
Mark Mascolini
Blacks, people with an AIDS history, and heterosexuals had slimmer chances of getting screened for hazardous alcohol use in an analysis of 11,330 people with HIV in the Kaiser Permanente healthcare system [1]. People who injected drugs or had a detectable viral load proved more likely to get screened for alcohol misuse.
Hazardous alcohol drinking remains common in people with HIV and may lead to poor antiretroviral adherence, loss of HIV control, and a daunting array of clinical complications. US health authorities recommend yearly alcohol use screening in all adults and adolescents, regardless of HIV status [2,3].
The Kaiser Permanente healthcare system began an alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) protocol in 2013. Researchers conducted this study to gauge screening uptake by clinicians treating people with HIV and to identify factors that raise or lower chances of screening.
The study involved all HIV-positive people at least 18 years old in the Kaiser Permanente system between July 2013 (when SBIRT began) and December 2017. The main outcome was alcohol use screening after SBIRT rollout, with follow-up until screening, death, loss to follow-up, or December 2017. The investigators used Kaplan-Meier analysis to estimate proportions screened and Cox regression models to isolate predictors of screening.
Of the 11,330 study participants, 9% were women, 55% 18 to 49 years old, 30% 50 to 59 years old, and 15% 60 or older. About half of the study group was white, 18% Hispanic, and 17% black. While 70% of participants picked up HIV infection during sex between men, 15% became infected heterosexually and 7% while injecting drugs. Almost half, 46%, had an AIDS-defining illness, 67% had a CD4 count at or above 500, and 89% had a viral load below 75 copies.
One year after SBIRT began, 68% of the cohort had an alcohol use screen. That proportion rose to 81% after 2 years, 86% after 3 years, and 89% after 4 years.
Adjusted analysis identified 5 factors independently linked to lower or higher chances of alcohol screening within 4 years of SBIRT rollout (at the following adjusted hazard ratios [aHR] and 95% confidence intervals [CI]):
Lowered chance of alcohol use screening:
Black (versus white) race: aHR 0.8, 95% CI 0.7 to 0.8, P < 0.001
Heterosexual (versus gay) HIV transmission: aHR 0.9, 95% CI 0.8 to 0.9, P < 0.001
Prior AIDS: aHR 0.9, 95% CI 0.8 to 0.9, P < 0.001
Raised chance of alcohol use screening:
Injection drug use (versus gay) HIV transmission: aHR 1.2, 95% CI 1.1 to 1.3, P < 0.001
Viral load at or above 75 copies (versus lower): aHR 1.2, 95% CI 1.1 to 1.3, P < 0.001
With 89% of HIV-positive people screened for hazardous drinking within 4 years, the Kaiser investigators rated the screening uptake "highly successful." They noted that the results may not apply to women with HIV (9% of the population) or to uninsured people (0% of the population). The Kaiser team plans follow-up studies to evaluate alcohol treatment programs in people with HIV and to compare outcomes with the general population.
References
1. Silverberg MJ, Levine-Hall T, Sterling SA, et al. Hazardous alcohol screening rates among persons with HIV following implementation of screening, brief intervention and referral to treatment in a large healthcare system in the United States. AIDS 2018: 22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018. Abstract WEPEB147.
2. US Preventive Services Task Force. Alcohol misuse: screening and behavioral counseling interventions in primary care. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/alcohol-misuse-screening-and-behavioral-counseling-interventions-in-primary-care
3. National Institute on Alcohol Abuse and Alcoholism. Alcohol screening and brief intervention for youth: a practitioner's guide. https://www.niaaa.nih.gov/publications/clinical-guides-and-manuals/alcohol-screening-and-brief-intervention-youth.
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