Substance abuse treatment and receipt of liver specialty care among persons coinfected with HIV/HCV who have alcohol problems

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2006.05.015 Byline: Anita Palepu (a), Debbie M. Cheng (b), Theresa Kim (c), David Nunes (d), John Vidaver (e), Julie Alperen (b), Richard Saitz (b)(f), Jeffrey H. Samet (b)(g) Keywords: Substance abuse; Hepatitis C virus; Liver specialty care; Substance abuse treatment Abstract: We examined the association of substance abuse treatment with access to liver specialty care among 231 persons coinfected with HIV and hepatitis C virus (HCV) with a history of alcohol problems who were recruited and followed up in the HIV-Longitudinal Interrelationships of Viruses and Ethanol cohort study from 2001 to 2004. Variables regarding demographics, substance use, health service use, clinical variables, and substance abuse treatment were from a standardized research questionnaire administered biannually. We defined substance abuse treatment services as any of the following in the previous 6 months: 12 weeks in a halfway house or residential facility, 12 visits to a substance abuse counselor or mental health professional, day treatment for at least 30 days, or any participation in a methadone maintenance program. Liver specialty care was defined as a visit to a liver doctor, a hepatologist, or a specialist in treating hepatitis C in the past 6 months. At study entry, most of the 231 subjects (89%, n = 205) had seen a primary care physician, 50% had been exposed to substance abuse treatment, and 50 subjects (22%) had received liver specialty care. An additional 33 subjects (14%) reported receiving liver specialty care during the follow-up period. In the multivariable model, we observed a clinically important although not statistically significant association between having been in substance abuse treatment and receiving liver specialty care (adjusted odds ratio = 1.38; 95% confidence interval = 0.9-2.11). Substance abuse treatment systems should give attention to the need of patients to receive care for prevalent treatable diseases such as HIV/HCV coinfection and facilitate its medical care to improve the quality of care for individuals with substance use disorders. The data illustrate the need for clinical care models that give explicit attention to the coordination of primary health care with addiction and hepatitis C specialty care while providing ongoing support to engage and retain these patients with complex health needs. Author Affiliation: (a) Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Department of Medicine, University of British Columbia, Vancouver, BC, Canada V6Z 1Y6 (b) Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA (c) Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA (d) Section of Gastroenterology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA (e) DM-STAT Inc., Malden, MA, USA (f) Youth Alcohol Prevention Center, and the Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA (g) Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA, USA Article History: Received 25 October 2005; Revised 4 May 2006; Accepted 16 May 2006