Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street Suite 120, Box 354805, Seattle, WA, 98105-4631, USA.
Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA.
AIDS Behav. 2018 Mar;22(3):742-751. doi: 10.1007/s10461-017-1826-2.
Substance use disorders (SUDs) are thought to predict care discontinuity, though magnitude and substance-specific variance of effects are unclear. This report of analytic work undertaken with a multi-regional American cohort of 9153 care enrollees addresses these gaps. Care retention was computed from 24-month post-linkage clinic visit documentation, with SUD cases identified from patient-report screening instruments. Two generalized estimating equations tested binary and hierarchial SUD predictors of retention, and potential effect modification by patient age-group, sex, and care site. Findings demonstrate: (1) detrimental SUD effect, equivalent to a nine percentage-point decrease in retention, with independent effects of age-group and care site; (2) substance-specific effect of marijuana UD associated with lower retention; and (3) age-modification of each effect on care discontinuity, with SUDs serving as a risk factor among 18-29 year-olds and protective factor among 60+ year-olds. Collective findings document patient attributes as influences that place particular subgroups at-risk to discontinue care.
物质使用障碍（SUD）被认为可预测治疗中断，但影响的幅度和物质特异性尚不清楚。本报告分析了来自美国多地区队列的 9153 名治疗参与者的资料，旨在解决这些差距。通过链接后的诊所就诊记录计算了治疗保留率，通过患者报告筛查工具确定了 SUD 病例。采用两种广义估计方程检验了保留率的二项和分层 SUD 预测因素，以及患者年龄组、性别和治疗地点的潜在调节作用。研究结果表明：（1）SUD 对治疗保留率有不利影响，相当于保留率降低了 9 个百分点，且受年龄组和治疗地点的独立影响；（2）与大麻使用障碍相关的物质特异性对保留率有影响；（3）每种效应在治疗中断方面的年龄修饰作用，SUD 在 18-29 岁人群中是一个风险因素，在 60 岁以上人群中是一个保护因素。总的来说，这些发现证明了患者属性是影响特定亚组人群停止治疗的因素。
