Title

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

Presenter

Michael Silverberg

Authors

M. Silverberg¹, T. Levine-Hall¹, S. Sterling¹, J. Lam¹, C. Ellis¹, M. Horberg², A. Williams³, C. Weisner^1,4, P. Volberding⁴, S. Parthasarathy¹, D. Satre^1,4

Institutions

¹Kaiser Permanente, Oakland, United States, ²Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, United States, ³Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, United States, ⁴University of California, San Francisco, United States

Background: Hazardous drinking is common among persons with HIV (PWH) and associated with reduced antiretroviral adherence, HIV viral control and substantial morbidity and mortality. Effective alcohol interventions in routine clinical care rely on robust screening for hazardous alcohol use. We evaluated the equality of screening rates across key subgroups among PWH following the rollout of Screening, Brief Intervention and Referral to Treatment (SBIRT) in a large integrated healthcare system in the United States.
Methods: We identified all adult PWH who were healthcare system members between July 2013 (rollout of SBIRT) and December 2017. Patients were followed until they were first screened (event of interest), or until death, lost-to-follow-up or December 2017. Factors evaluated included baseline age, sex, race/ethnicity (Black, White, Hispanic, Other), HIV transmission risk (heterosexual, injection drug use [IDU], men who have sex with men [MSM]), and prior AIDS defining illness (ADI). We estimated proportions screened from Kaplan-Meier plots and adjusted hazard ratios (HRs) from Cox Regression models.
Results: A total of 11,330 PWH were included, with 70% MSM, 52% White, 45% ≥50 years of age at baseline and 46% with prior ADI. Overall, 89% of PWH were screened by four years after SBIRT rollout. Screening was less likely among those 50-59 years (87%; HR 0.93, 95% CI 0.89-0.98) compared with those 18-49 years of age (90%; reference); less likely among Blacks (83%; HR 0.78, 95% CI 0.74-0.83) compared with Whites (90%; reference); less likely among heterosexuals (84%; HR 0.89, 95% CI 0.82-0.96) and higher among IDU (93%; HR 1.19, 95% CI 1.10-1.29) compared with MSM (89%; reference); and less likely among those with prior ADI (86%; HR 0.83, 95% CI 0.80-0.87) compared with those without prior ADI (91%; reference).
Conclusions: Screening for hazardous alcohol use was highly successful with 89% of all PWH screened after four years. However, demographic and clinical disparities suggest strategies are needed to reduce such screening disparities among PWH to allow for equal access to appropriate treatment.