治疗启动、物质使用轨迹与寻求阿片类药物使用障碍药物治疗的 HIV 感染者的健康社会决定因素。

Treatment Initiation, Substance Use Trajectories, and the Social Determinants of Health in Persons Living With HIV Seeking Medication for Opioid Use Disorder.

机构信息

Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland, OR, USA.

Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois-Chicago, Chicago, IL, USA.

出版信息

Subst Abus. 2023 Oct;44(4):301-312. doi: 10.1177/08897077231200745. Epub 2023 Oct 16.

DOI:10.1177/08897077231200745

PMID:37842910

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10830143/

Abstract

BACKGROUND

People living with HIV and opioid use disorder (OUD) are disproportionally affected by adverse socio-structural exposures negatively affecting health, which have shown inconsistent associations with uptake of medications for OUD (MOUD). This study aimed to determine whether social determinants of health (SDOH) were associated with MOUD uptake and trajectories of substance use in a clinical trial of people seeking treatment.

METHODS

Data are from a 2018 to 2019 randomized trial comparing the effectiveness of different MOUD to achieve viral suppression among people living with HIV and OUD. SDOH were defined by variables mapping to Healthy People 2030 domains: education (Education Access and Quality), income (Economic Stability), homelessness (Neighborhood and Built Environment), criminal justice involvement (Social and Community Context), and recent SUD care (Health Care Access and Quality). Associations between SDOH and MOUD initiation were assessed with Cox proportional hazards models, and SDOH and substance use over time with generalized estimating equation models.

RESULTS

Participants (N = 114) averaged 47 years old, 63% were male, 56% were Black, and 12% Hispanic. Participants reported an average of 2.3 out of 5 positive SDOH indicators (SD = 1.2). Stable housing was the most commonly reported SDOH (61%), followed by no recent criminal justice involvement (59%), having a high-school level education or greater (56%), income stability (45%), and recent SUD care (13%). Each additional favorable SDOH was associated with a 25% increase in the likelihood of MOUD initiation during the study period [adjusted HR = 1.25, 95% CI = (1.01, 1.55), = .044]. Positive SDOH were also associated with a decrease in the odds of baseline opioid use and a greater reduction in opioid use during subsequent weeks of the study ( < .001 for a joint test of baseline and slope differences).

CONCLUSIONS

Positive social determinants of health, in aggregate, may increase the likelihood of MOUD treatment initiation among people living with HIV and OUD.

摘要

背景

艾滋病毒感染者和阿片类药物使用障碍（OUD）患者受到不利社会结构因素的不成比例影响，这些因素对健康产生负面影响，而这些因素与 OUD（MOUD）药物的使用情况不一致。本研究旨在确定健康的社会决定因素（SDOH）是否与接受治疗的寻求治疗的 HIV 感染者和 OUD 患者的 MOUD 使用率和物质使用轨迹相关。

方法

数据来自 2018 年至 2019 年的一项随机试验，该试验比较了不同 MOUD 对实现 HIV 感染者和 OUD 患者病毒抑制的效果。SDOH 通过映射到健康人 2030 年目标领域的变量来定义：教育（教育机会和质量）、收入（经济稳定）、无家可归（邻里和建筑环境）、刑事司法参与（社会和社区环境）以及最近的 SUD 护理（医疗保健机会和质量）。使用 Cox 比例风险模型评估 SDOH 与 MOUD 起始之间的关联，使用广义估计方程模型评估 SDOH 与物质使用随时间的变化。

结果

参与者（N=114）平均年龄为 47 岁，63%为男性，56%为黑人，12%为西班牙裔。参与者报告了平均 2.3 个 5 个阳性 SDOH 指标（SD=1.2）。稳定的住房是最常见的 SDOH（61%），其次是最近没有刑事司法参与（59%）、高中及以上学历（56%）、收入稳定（45%）和最近的 SUD 护理（13%）。在研究期间，每增加一个有利的 SDOH，MOUD 起始的可能性就会增加 25%[调整后的 HR=1.25，95%CI=（1.01，1.55），p=0.044]。积极的 SDOH 也与基线阿片类药物使用的几率降低以及研究后续几周阿片类药物使用的减少有关（联合检验基线和斜率差异的 P<.001）。