Claudia Taccheri Catherine Lesko Oluwaseun O FaladeNwulia February 3 2023 HIV Care Retention in Baltimore Baltimore City Annual HIV Epidemiological Profile 2020 Center for HIV Surveillance Epidemiology and Evaluation Maryland Department of Health Baltimore MD 2021 ID: 1003270
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1. 1HIV care retention among people who have recently used opioids or cocaineClaudia Taccheri, Catherine Lesko, Oluwaseun O Falade-NwuliaFebruary 3, 2023
2. HIV Care Retention in Baltimore Baltimore City Annual HIV Epidemiological Profile 2020. Center for HIV Surveillance, Epidemiology and Evaluation, Maryland Department of Health, Baltimore, MD. 2021. Of the 18,276 people living with HIV in Baltimore-Columbia-Towson MSA in 2019, 63.9% were virally suppressed.In 2015, 77% of Marylanders retained in HIV care were virally suppressedMaryland’s Integrated HIV Plan 2020 Goal: 80% virally suppressed
3. HIV and Substance UseHalf of adults receiving HIV care report substance use in the year preceding care, and 12% report dependence [Bing]Among people who report substance use, retention in HIV care is associated with increased antiretroviral therapy use [Lucas]Intermittent usePersistent useNo useSurvival of individuals infected with HIV according to cocaine/heroin usePoor retention in HIV care is associated with >2X mortality rates [Mugavero]Intermittent users with HIV experience more opportunistic infection during periods of active use [Lucas]Little known about how time-varying cocaine and opioid use differentially impact HIV care
4. PurposeUnderstand the association between recent cocaine / opioid use on retention in continuity HIV care
5. MethodsPatients ≥ 18 years enrolled in Johns Hopkins HIV Clinical Cohort and engaged in HIV care at the John G. Bartlett Specialty Practice who are receiving ARTCompleted at least one patient reported outcome computer assisted self-interviews (PRO) between 1/1/2012-3/15/2019 and had at least one scheduled HIV primary care visit in the year following their PRODemographic data, laboratory values, diagnoses, and medication prescriptions extracted from EMR Patients self-reported prior 90 day substance use through PRO elicited at time of clinic visit
6. Methods Outcome – HIV care retention: percent of scheduled visits attended in year after PRO completion Exposure – self-reported cocaine/opioid use in 90 days preceding visitAnalysisUnivariate logistic and multivariate generalized estimating equation regression run using STATAHigh retention (≥ 75% visits attended)Repeat PROs included in analysis if more than 90 days apart
7. The Study Population
8. Cocaine but not opioid use is associated with decreased visit adherence
9. ConclusionRecent cocaine use only but not recent opioid use only was associated with decreased visit adherenceComorbid cocaine and opioid use was associated with decreased visit adherence
10. Next StepsUnderstand drivers of reduced retention and pathways to increasing retentionConsider impact of Covid-19 on care engagement in this patient populationDo we see the same trends for in-person visits vs telehealth appointments?How does care engagement interact with morbidity and mortality in this patient population?
11. Thank You!Catherine LeskoOluwaseun O Falade-Nwulia
12. Thank You!
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14. Substance Related Deaths in MarylandUnintentional Drug and Alcohol-Related Intoxication Deaths Report 2020, Maryland Department of Health, Baltimore, MD
15. Percent of Visits AttendedOpioid UseCocaine UseCocaine & Opioid UseNeither