Influence of Substance Use Disorders on 2-Year HIV Care Retention in the United States

Bryan Hartzler, Julia C. Dombrowski, Jason R. Williams, Heidi M. Crane, Joseph J. Eron, Elvin H. Geng, Christopher Mathews, Kenneth H. Mayer, Richard D. Moore, Michael J. Mugavero, Sonia Napravnik, Benigno Rodriguez, Dennis M. Donovan

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)742-751
Number of pages10
JournalAIDS and behavior
Issue number3
StatePublished - Mar 1 2018


  • Care retention
  • HIV care settings
  • Substance use disorders
  • United States

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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