Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
Data Science Core, Boston CSPCC, VA Boston Healthcare System, Boston, MA, USA.
J Gen Intern Med. 2024 Feb;39(3):403-410. doi: 10.1007/s11606-023-08452-5. Epub 2023 Oct 17.
Veterans face high risk for HIV and substance use, and thus could be disproportionately impacted by the HIV and substance use disorder (SUD) "syndemic." HIV prevalence among veterans with SUD is unknown.
To project HIV prevalence and lifetime HIV screening history among US veterans with alcohol use disorder (AUD), opioid use disorder (OUD), or both.
We conducted a retrospective cohort analysis using national Veterans Health Administration (VHA) data.
We selected three cohorts of veterans with SUD: (1) AUD, (2) OUD, and (3) AUD/OUD. Included veterans had ICD codes for AUD/OUD from 2016 to 2022 recorded in VHA electronic medical records, sourced from the VA Corporate Data Warehouse (CDW).
We estimated HIV prevalence by dividing the number of veterans who met two out of three criteria (codes for HIV diagnosis, antiretroviral therapy, or HIV screening/monitoring) by the total number of veterans in each cohort. We also estimated lifetime HIV screening history (as documented in VHA data) by cohort. We reported HIV prevalence and screening history by cohort and across demographic/clinical subgroups.
Our sample included 669,595 veterans with AUD, 63,787 with OUD, and 57,015 with AUD/OUD. HIV prevalence was highest in the AUD/OUD cohort (3.9%), followed by the OUD (2.1%) and AUD (1.1%) cohorts. Veterans of Black race and Hispanic/Latinx ethnicity, with HCV diagnoses, and aged 50-64 had the highest HIV prevalence in all cohorts. Overall, 12.8%, 29.1%, and 33.1% of the AUD/OUD, OUD, and AUD cohorts did not have history of HIV screening, respectively.
HIV prevalence was high in all SUD cohorts, and was highest among veterans with AUD/OUD, with disparities by race/ethnicity and age. A substantial portion of veterans had not received HIV screening in the VHA. Findings highlight room for improvement in HIV prevention and screening services for veterans with SUD.
退伍军人面临着较高的 HIV 和药物使用风险，因此可能会受到 HIV 和药物使用障碍（SUD）“综合征”的不成比例的影响。患有 SUD 的退伍军人中的 HIV 流行率尚不清楚。
预测美国患有酒精使用障碍（AUD）、阿片类药物使用障碍（OUD）或两者兼有的退伍军人中的 HIV 流行率和终生 HIV 筛查史。
我们使用全国退伍军人健康管理局（VHA）的数据进行了回顾性队列分析。
我们选择了 SUD 的三个队列的退伍军人：（1）AUD，（2）OUD，和（3）AUD/OUD。包含的退伍军人在 VHA 电子病历中有 AUD/OUD 的 ICD 编码，这些编码来自 VA 企业数据仓库（CDW）。
我们通过将符合两个三个标准（HIV 诊断、抗逆转录病毒治疗或 HIV 筛查/监测的代码）的退伍军人人数除以每个队列的退伍军人总数，来估计 HIV 流行率。我们还根据队列估计了终生 HIV 筛查史（记录在 VHA 数据中）。我们按队列和按人口统计学/临床亚组报告 HIV 流行率和筛查史。
我们的样本包括 669595 名患有 AUD 的退伍军人、63787 名患有 OUD 的退伍军人和 57015 名患有 AUD/OUD 的退伍军人。HIV 流行率在 AUD/OUD 队列中最高（3.9%），其次是 OUD（2.1%）和 AUD（1.1%）队列。在所有队列中，黑人和西班牙裔/拉丁裔退伍军人、患有丙型肝炎病毒（HCV）诊断和年龄在 50-64 岁的退伍军人 HIV 流行率最高。总体而言，AUD/OUD、OUD 和 AUD 队列中分别有 12.8%、29.1%和 33.1%的退伍军人没有 HIV 筛查史。
所有 SUD 队列中的 HIV 流行率都很高，在 AUD/OUD 队列中的退伍军人中最高，并且存在种族/民族和年龄方面的差异。很大一部分退伍军人在 VHA 中没有接受 HIV 筛查。这些发现突显了在 SUD 退伍军人中改进 HIV 预防和筛查服务的空间。
