Division of Emergency Medicine, Department of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd. MS # 113, Los Angeles, CA, USA.
Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
AIDS Behav. 2024 Dec;28(12):4020-4028. doi: 10.1007/s10461-024-04483-z. Epub 2024 Sep 3.
We sought to investigate the association between hazardous alcohol use and gaps in care for people living with HIV over a long-term follow-up period. Adults who had participated in our previously published Phase I study of hazardous alcohol use at HIV programs in Kenya and Uganda were eligible at their 42 to 48 month follow-up visit. Those who re-enrolled were followed for an additional ~ 12 months. Hazardous alcohol use behavior was measured using the Alcohol Use Disorders Identification Test (AUDIT) tool. Deidentified clinical data were used to assess gaps in care (defined as failure to return to clinic within 60 days after a missed visit). The proportion of patients experiencing a gap in care at a specific time point was based on a nonparametric moment-based estimator. A semiparametric Cox proportional hazard model was used to determine the association between hazardous alcohol use at enrollment in Phase I (AUDIT score ≥ 8) and gaps in care. Of the 731 study-eligible participants from Phase I, 5.5% had died, 10.1% were lost to follow-up, 39.5% transferred, 7.5% declined/not approached, and 37.3% were enrolled. Phase II participants were older, had less hazardous drinking and had a lower WHO clinical stage than those not re-enrolled. Hazardous drinking in the re-enrolled was associated with a Hazard Ratio (HR) of 1.88 [p-value = 0.016] for a gap in care. Thus, hazardous alcohol use at baseline was associated with an increased risk of experiencing a gap in care and presents an early target for intervention.
我们旨在探讨在长期随访期间，艾滋病毒感染者中危险饮酒与护理缺失之间的关联。在肯尼亚和乌干达的艾滋病毒项目中参加过我们之前发表的第一阶段危险饮酒研究的成年人，在第 42 至 48 个月的随访访问时符合条件。重新入组的人将再随访约 12 个月。使用酒精使用障碍识别测试 (AUDIT) 工具测量危险饮酒行为。使用去识别的临床数据评估护理缺失（定义为错过就诊后 60 天内未返回诊所）。特定时间点出现护理缺失的患者比例基于非参数矩估计量。半参数 Cox 比例风险模型用于确定第一阶段入组时危险饮酒（AUDIT 评分≥8）与护理缺失之间的关联。在第一阶段的 731 名符合条件的研究参与者中，5.5%死亡，10.1%失访，39.5%转院，7.5%拒绝/未接触，37.3%入组。第二阶段的参与者年龄更大，饮酒更危险，世界卫生组织临床分期也比未重新入组的参与者低。重新入组者的危险饮酒与护理缺失的风险比 (HR) 为 1.88[p 值=0.016]。因此，基线时的危险饮酒与发生护理缺失的风险增加有关，这是早期干预的目标。
