Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV

Benjamin J. Oldfield, Kathleen A. McGinnis, E. Jennifer Edelman, Emily C. Williams, Adam J. Gordon, Kathleen Akgün, Stephen Crystal, Lynn E. Fiellin, Julie R. Gaither, Joseph L. Goulet, P. Todd Korthuis, Brandon D.L. Marshall, Amy C. Justice, Kendall Bryant, David A. Fiellin, Kevin L. Kraemer

Research output: Contribution to journalArticle

Abstract

Introduction: Infrequent use of and poor retention on evidence-based medications for alcohol use disorder (MAUD) represent a treatment gap, particularly among people living with HIV (PLWH). We examined predictors of MAUD initiation and retention across HIV status. Methods: From Veterans Aging Cohort Study (VACS) data, we identified new alcohol use disorder (AUD) diagnoses from 1998 to 2015 among 163,339 individuals (50,826 PLWH and 112,573 uninfected, matched by age, sex, and facility). MAUD initiation was defined as a prescription fill for naltrexone, acamprosate or disulfiram within 30 days of a new diagnosis. Among those who initiated, retention was defined as filling medication for ≥80% of days over the following six months. We used multivariable logistic regression to assess patient- and facility-level predictors of AUD medication initiation across HIV status. Results: Among 10,603 PLWH and 24,424 uninfected individuals with at least one AUD episode, 359 (1.0%) initiated MAUD and 49 (0.14%) were retained. The prevalence of initiation was lower among PLWH than those without HIV (adjusted odds ratio [AOR] 0.66, 95% confidence interval [CI] 0.51–0.85). Older age (for PLWH: AOR 0.78, 95% CI 0.61–0.99; for uninfected: AOR 0.70, 95% CI 0.61–0.80) and black race (for PLWH: AOR 0.63, 95% CI 0.0.49–0.1.00; for uninfected: AOR 0.63, 95% CI 0.48–0.83), were associated with decreased odds of initiation for both groups. The low frequency of retention precluded multivariable analyses for retention. Conclusions: For PLWH and uninfected individuals, targeted implementation strategies to expand MAUD are needed, particularly for specific subpopulations (e.g. black PLWH).

Original languageEnglish (US)
Pages (from-to)14-22
Number of pages9
JournalJournal of Substance Abuse Treatment
Volume109
DOIs
StatePublished - Feb 2020

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Alcohols
HIV
Odds Ratio
Confidence Intervals
Disulfiram
Naltrexone
Veterans
Prescriptions
Cohort Studies
Logistic Models

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Medicine (miscellaneous)
  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Oldfield, B. J., McGinnis, K. A., Edelman, E. J., Williams, E. C., Gordon, A. J., Akgün, K., ... Kraemer, K. L. (2020). Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV. Journal of Substance Abuse Treatment, 109, 14-22. https://doi.org/10.1016/j.jsat.2019.11.002

Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV. / Oldfield, Benjamin J.; McGinnis, Kathleen A.; Edelman, E. Jennifer; Williams, Emily C.; Gordon, Adam J.; Akgün, Kathleen; Crystal, Stephen; Fiellin, Lynn E.; Gaither, Julie R.; Goulet, Joseph L.; Korthuis, P. Todd; Marshall, Brandon D.L.; Justice, Amy C.; Bryant, Kendall; Fiellin, David A.; Kraemer, Kevin L.

In: Journal of Substance Abuse Treatment, Vol. 109, 02.2020, p. 14-22.

Research output: Contribution to journalArticle

Oldfield, BJ, McGinnis, KA, Edelman, EJ, Williams, EC, Gordon, AJ, Akgün, K, Crystal, S, Fiellin, LE, Gaither, JR, Goulet, JL, Korthuis, PT, Marshall, BDL, Justice, AC, Bryant, K, Fiellin, DA & Kraemer, KL 2020, 'Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV', Journal of Substance Abuse Treatment, vol. 109, pp. 14-22. https://doi.org/10.1016/j.jsat.2019.11.002
Oldfield, Benjamin J. ; McGinnis, Kathleen A. ; Edelman, E. Jennifer ; Williams, Emily C. ; Gordon, Adam J. ; Akgün, Kathleen ; Crystal, Stephen ; Fiellin, Lynn E. ; Gaither, Julie R. ; Goulet, Joseph L. ; Korthuis, P. Todd ; Marshall, Brandon D.L. ; Justice, Amy C. ; Bryant, Kendall ; Fiellin, David A. ; Kraemer, Kevin L. / Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV. In: Journal of Substance Abuse Treatment. 2020 ; Vol. 109. pp. 14-22.
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abstract = "Introduction: Infrequent use of and poor retention on evidence-based medications for alcohol use disorder (MAUD) represent a treatment gap, particularly among people living with HIV (PLWH). We examined predictors of MAUD initiation and retention across HIV status. Methods: From Veterans Aging Cohort Study (VACS) data, we identified new alcohol use disorder (AUD) diagnoses from 1998 to 2015 among 163,339 individuals (50,826 PLWH and 112,573 uninfected, matched by age, sex, and facility). MAUD initiation was defined as a prescription fill for naltrexone, acamprosate or disulfiram within 30 days of a new diagnosis. Among those who initiated, retention was defined as filling medication for ≥80{\%} of days over the following six months. We used multivariable logistic regression to assess patient- and facility-level predictors of AUD medication initiation across HIV status. Results: Among 10,603 PLWH and 24,424 uninfected individuals with at least one AUD episode, 359 (1.0{\%}) initiated MAUD and 49 (0.14{\%}) were retained. The prevalence of initiation was lower among PLWH than those without HIV (adjusted odds ratio [AOR] 0.66, 95{\%} confidence interval [CI] 0.51–0.85). Older age (for PLWH: AOR 0.78, 95{\%} CI 0.61–0.99; for uninfected: AOR 0.70, 95{\%} CI 0.61–0.80) and black race (for PLWH: AOR 0.63, 95{\%} CI 0.0.49–0.1.00; for uninfected: AOR 0.63, 95{\%} CI 0.48–0.83), were associated with decreased odds of initiation for both groups. The low frequency of retention precluded multivariable analyses for retention. Conclusions: For PLWH and uninfected individuals, targeted implementation strategies to expand MAUD are needed, particularly for specific subpopulations (e.g. black PLWH).",
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T1 - Predictors of initiation of and retention on medications for alcohol use disorder among people living with and without HIV

AU - Oldfield, Benjamin J.

AU - McGinnis, Kathleen A.

AU - Edelman, E. Jennifer

AU - Williams, Emily C.

AU - Gordon, Adam J.

AU - Akgün, Kathleen

AU - Crystal, Stephen

AU - Fiellin, Lynn E.

AU - Gaither, Julie R.

AU - Goulet, Joseph L.

AU - Korthuis, P. Todd

AU - Marshall, Brandon D.L.

AU - Justice, Amy C.

AU - Bryant, Kendall

AU - Fiellin, David A.

AU - Kraemer, Kevin L.

PY - 2020/2

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N2 - Introduction: Infrequent use of and poor retention on evidence-based medications for alcohol use disorder (MAUD) represent a treatment gap, particularly among people living with HIV (PLWH). We examined predictors of MAUD initiation and retention across HIV status. Methods: From Veterans Aging Cohort Study (VACS) data, we identified new alcohol use disorder (AUD) diagnoses from 1998 to 2015 among 163,339 individuals (50,826 PLWH and 112,573 uninfected, matched by age, sex, and facility). MAUD initiation was defined as a prescription fill for naltrexone, acamprosate or disulfiram within 30 days of a new diagnosis. Among those who initiated, retention was defined as filling medication for ≥80% of days over the following six months. We used multivariable logistic regression to assess patient- and facility-level predictors of AUD medication initiation across HIV status. Results: Among 10,603 PLWH and 24,424 uninfected individuals with at least one AUD episode, 359 (1.0%) initiated MAUD and 49 (0.14%) were retained. The prevalence of initiation was lower among PLWH than those without HIV (adjusted odds ratio [AOR] 0.66, 95% confidence interval [CI] 0.51–0.85). Older age (for PLWH: AOR 0.78, 95% CI 0.61–0.99; for uninfected: AOR 0.70, 95% CI 0.61–0.80) and black race (for PLWH: AOR 0.63, 95% CI 0.0.49–0.1.00; for uninfected: AOR 0.63, 95% CI 0.48–0.83), were associated with decreased odds of initiation for both groups. The low frequency of retention precluded multivariable analyses for retention. Conclusions: For PLWH and uninfected individuals, targeted implementation strategies to expand MAUD are needed, particularly for specific subpopulations (e.g. black PLWH).

AB - Introduction: Infrequent use of and poor retention on evidence-based medications for alcohol use disorder (MAUD) represent a treatment gap, particularly among people living with HIV (PLWH). We examined predictors of MAUD initiation and retention across HIV status. Methods: From Veterans Aging Cohort Study (VACS) data, we identified new alcohol use disorder (AUD) diagnoses from 1998 to 2015 among 163,339 individuals (50,826 PLWH and 112,573 uninfected, matched by age, sex, and facility). MAUD initiation was defined as a prescription fill for naltrexone, acamprosate or disulfiram within 30 days of a new diagnosis. Among those who initiated, retention was defined as filling medication for ≥80% of days over the following six months. We used multivariable logistic regression to assess patient- and facility-level predictors of AUD medication initiation across HIV status. Results: Among 10,603 PLWH and 24,424 uninfected individuals with at least one AUD episode, 359 (1.0%) initiated MAUD and 49 (0.14%) were retained. The prevalence of initiation was lower among PLWH than those without HIV (adjusted odds ratio [AOR] 0.66, 95% confidence interval [CI] 0.51–0.85). Older age (for PLWH: AOR 0.78, 95% CI 0.61–0.99; for uninfected: AOR 0.70, 95% CI 0.61–0.80) and black race (for PLWH: AOR 0.63, 95% CI 0.0.49–0.1.00; for uninfected: AOR 0.63, 95% CI 0.48–0.83), were associated with decreased odds of initiation for both groups. The low frequency of retention precluded multivariable analyses for retention. Conclusions: For PLWH and uninfected individuals, targeted implementation strategies to expand MAUD are needed, particularly for specific subpopulations (e.g. black PLWH).

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