Improving linkage and retention in treatment among people living with HIV and comorbid substance use

AbstractContradictory data have been reported concerning neuropsychiatric side effects of the first-line antiretroviral drug dolutegravir, which may be partly due to lack of control groups or psychiatric assessment tools. Using validated self-report questionnaires, we compared mood and anxiety (DASS-42), impulsivity (BIS-11), and substance use (MATE-Q) between dolutegravir-treated and dolutegravir-naive people living with HIV (PLHIV). We analyzed 194, mostly male, PLHIV on long-term treatment of whom 82/194 (42.3%) used dolutegravir for a median (IQR) of 280 (258) days. Overall, 51/194 (26.3%) participants reported DASS-42 scores above the normal cut-off, 27/194 (13.5%) were classified as highly impulsive, and 58/194 (29.9%) regularly used recreational drugs. Regular substance use was positively associated with depression (p = 0.012) and stress scores (p = 0.045). We observed no differences between dolutegravir-treated and dolutegravir-naive PLHIV. Our data show that depressed and anxious moods and impulsivity are common in PLHIV and associate with substance use and not with dolutegravir use.

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Natural Language Processing of Clinical Notes to Identify Mental Illness and Substance Use Among People Living with HIV: Retrospective Cohort Study (Preprint)

10.2196/preprints.23456 ◽

2020 ◽

Author(s):

Jessica P Ridgway ◽

Arno Uvin ◽

Jessica Schmitt ◽

Tomasz Oliwa ◽

Ellen Almirol ◽

...

Keyword(s):

Mental Illness ◽

Substance Use ◽

Natural Language Processing ◽

Language Processing ◽

Predictive Value ◽

Hiv Care ◽

People Living With Hiv ◽

Clinical Notes ◽

Unstructured Text ◽

Living With Hiv

BACKGROUND Mental illness and substance use are prevalent among people living with HIV and often lead to poor health outcomes. Electronic medical record (EMR) data are increasingly being utilized for HIV-related clinical research and care, but mental illness and substance use are often underdocumented in structured EMR fields. Natural language processing (NLP) of unstructured text of clinical notes in the EMR may more accurately identify mental illness and substance use among people living with HIV than structured EMR fields alone. OBJECTIVE The aim of this study was to utilize NLP of clinical notes to detect mental illness and substance use among people living with HIV and to determine how often these factors are documented in structured EMR fields. METHODS We collected both structured EMR data (diagnosis codes, social history, Problem List) as well as the unstructured text of clinical HIV care notes for adults living with HIV. We developed NLP algorithms to identify words and phrases associated with mental illness and substance use in the clinical notes. The algorithms were validated based on chart review. We compared numbers of patients with documentation of mental illness or substance use identified by structured EMR fields with those identified by the NLP algorithms. RESULTS The NLP algorithm for detecting mental illness had a positive predictive value (PPV) of 98% and a negative predictive value (NPV) of 98%. The NLP algorithm for detecting substance use had a PPV of 92% and an NPV of 98%. The NLP algorithm for mental illness identified 54.0% (420/778) of patients as having documentation of mental illness in the text of clinical notes. Among the patients with mental illness detected by NLP, 58.6% (246/420) had documentation of mental illness in at least one structured EMR field. Sixty-three patients had documentation of mental illness in structured EMR fields that was not detected by NLP of clinical notes. The NLP algorithm for substance use detected substance use in the text of clinical notes in 18.1% (141/778) of patients. Among patients with substance use detected by NLP, 73.8% (104/141) had documentation of substance use in at least one structured EMR field. Seventy-six patients had documentation of substance use in structured EMR fields that was not detected by NLP of clinical notes. CONCLUSIONS Among patients in an urban HIV care clinic, NLP of clinical notes identified high rates of mental illness and substance use that were often not documented in structured EMR fields. This finding has important implications for epidemiologic research and clinical care for people living with HIV.

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Potential Influences of the COVID-19 Pandemic on Drug Use and HIV Care Among People Living with HIV and Substance Use Disorders: Experience from a Pilot mHealth Intervention

AIDS and Behavior ◽

10.1007/s10461-020-02976-1 ◽

2020 ◽

Author(s):

Karli R. Hochstatter ◽

Wajiha Z. Akhtar ◽

Sarah Dietz ◽

Klaren Pe-Romashko ◽

David H. Gustafson ◽

...

Keyword(s):

Substance Use ◽

Drug Use ◽

Substance Use Disorders ◽

Hiv Care ◽

People Living With Hiv ◽

Mhealth Intervention ◽

Living With Hiv

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1318. Examining Multimorbidity as a Moderating Effect on the Relationship Between Substance Use and Viral Suppression Among People Living with HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1181 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S476-S476

Author(s):

Timothy N Crawford ◽

Alice Thornton

Keyword(s):

Substance Use ◽

Viral Load ◽

Chronic Conditions ◽

Viral Suppression ◽

Moderating Effect ◽

Multiple Chronic Conditions ◽

People Living With Hiv ◽

Substance Users ◽

Living With Hiv ◽

The Relationship

Abstract Background Substance use and multimorbidity (≥2 chronic conditions) are highly prevalent among people living with HIV (PLWH). However, their impact on achieving viral suppression are not well understood. The purpose of this study was to examine the relationship between substance use and viral suppression and the potential moderating effect of multimorbidity. Methods A retrospective cohort study was conducted at an academic Ryan White Funded clinic in central Kentucky. Individuals were included if they were diagnosed with HIV, seeking care between 2010 and 2014, had at least one year of follow-up, and did not have a chronic condition at the time they entered care. The primary independent variable was substance use which included alcohol, nicotine use, and/or illicit drug use; the moderating variable was multimorbidity (0, 1, ≥2 chronic conditions); and outcome was viral suppression (≤50 copies/mL). A logistic regression model was developed to examine the interaction between substance use and multimorbidity on achieving viral load suppression. The model controlled for medication adherence, insurance status, age, and CD4+ cell counts. Results A total of 941 individuals were included in the study, with an average age of 43.9 ± 11.7 years. Approximately 67.0% reported substance use; 54% had ≥2 chronic conditions diagnosed. The three most prevalent conditions diagnosed were hypertension (34.6%), mental health (33.9%), and diabetes (21.5%) Approximately 61.0% of substance users had ≥2 conditions. Those with viral suppression were less likely to be substance users, but were more likely to have ≥2 conditions compared with their counterparts. There was a significant interaction between substance use and multimorbidity (P = 0.037). Stratified by multimorbidity, substance use was associated with unsuppressed viral loads; among those with ≥2 chronic conditions substance users had lower odds of achieving viral suppression compared with nonusers (OR=0.24; 95% CI=0.10–0.55). Conclusion Substance use may impede the opportunity for PLWH to achieve viral suppression, increasing their risk of transmission and progression of disease. More research is needed to understand the role substance use plays in impacting viral load, specifically among those with multiple chronic conditions. Disclosures All authors: No reported disclosures.

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Mental health disorders and substance use among people living with HIV in Nepal: their influence on non-adherence to anti-retroviral therapy

AIDS Care ◽

10.1080/09540121.2019.1587365 ◽

2019 ◽

Vol 31 (8) ◽

pp. 923-931 ◽

Cited By ~ 1

Author(s):

Khem Narayan Pokhrel ◽

Kalpana Gaulee Pokhrel ◽

Vidya Dev Sharma ◽

Krishna Chandra Poudel ◽

Sanjeev Raj Neupane ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

Mental Health Disorders ◽

People Living With Hiv ◽

Health Disorders ◽

Living With Hiv

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Patterns of substance use and arrest among hospitalized people living with HIV: A latent class analysis

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2016.08.519 ◽

2017 ◽

Vol 171 ◽

pp. e189-e190 ◽

Cited By ~ 1

Author(s):

Karen Shiu ◽

Ahnalee Marie Brincks ◽

Daniel J. Feaster ◽

Jemima A. Frimpong ◽

Lauren Gooden ◽

...

Keyword(s):

Substance Use ◽

Latent Class Analysis ◽

Latent Class ◽

People Living With Hiv ◽

Class Analysis ◽

Living With Hiv

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Feasibility and Acceptability of a Smartphone App for Daily Reports of Substance Use and Antiretroviral Therapy Adherence among HIV-Infected Adults

AIDS Research and Treatment ◽

10.1155/2016/9510172 ◽

2016 ◽

Vol 2016 ◽

pp. 1-12 ◽

Cited By ~ 9

Author(s):

Sarahmona M. Przybyla ◽

Rebecca K. Eliseo-Arras ◽

Gabriela Krawiec ◽

Emily Gower ◽

Kurt Dermen

Keyword(s):

Substance Use ◽

Antiretroviral Therapy ◽

Smartphone Application ◽

People Living With Hiv ◽

Antiretroviral Therapy Adherence ◽

High Satisfaction ◽

Daily Report ◽

Acceptable Method ◽

Living With Hiv ◽

Depth Interviews

While substance use is one of the most consistent predictors of poor adherence to antiretroviral therapy (ART), few studies among people living with HIV (PLH) have utilized mobile phone-based assessment of these health behaviors. PLH were recruited from primary care clinics to report ART and substance use using a smartphone application (app) for 14 consecutive days. The app’s feasibility as a data collection tool was evaluated quantitatively via surveys and qualitatively via in-depth interviews to assess daily report completion, compliance, and study satisfaction. Overall, 26 participants (M=49.5years, 76% male) completed 95.3% of time-based daily reports. Participants reported high satisfaction with the app and expressed future interest in using smartphones to report daily behaviors. High completion rates and participant acceptability suggest that smartphones are a feasible, acceptable method for collecting substance use and ART data among PLH. Potential areas of concern such as sufficient training and assistance for those with limited smartphone experience should be considered for future app-based research studies among PLH.

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