2052. Problem Drinking in HIV + and - Veterans: Prevalence and Provider Awareness
Joseph Conigliaro, MD, MPH, K McGinnis, , AJ Gordon, , KL Kraemer, , N Day, , J Samet, , SL Fultz, , D Rimland, , AC Justice,
Objectives: Problem drinking likely influences HIV care but can we generalize alcohol studies in primary care to HIV care? We compare prevalence and provider awareness of problem drinking among HIV + and - veterans at 5 VAs.
Methods: We used AUDIT or binge drinking to assess problem drinking (AUDIT/Binge), asked patient’s providers to determine if they “drank too much” and ICD-9 codes to document alcohol diagnoses (last 5 yrs) among 1,031 HIV + (mean age 49) and 740 HIV - veterans (mean age 55). We determined agreement between provider assessment and alcohol measures and identified patient characteristics predicting providers missing problem drinking.
Results: Problem drinking was prevalent in both groups (33%) and unchanged after adjusting for age and race. Providers underestimated problem drinking: HIV providers reported 12% of patients “drinking too much” compared to non HIV providers who reported 9%. Among patients who drink, HIV providers correctly classified problem drinking in 20% compared to non HIV providers who classified 31%. HIV + veterans more often had ICD-9 diagnoses than HIV - veterans (25% vs. 18%). Provider diagnosis was specific (96%), but insensitive (25%) compared to AUDIT/Binge. HIV status (OR=1.9, p=.01) was associated with missing problem drinking in univariate models. Similar results were seen with ICD-9 diagnoses.
Conclusions: Problem drinking and alcohol diagnoses are highly prevalent among HIV + and - veterans, but often undetected by providers. Both primary care and HIV providers were usually correct when suspecting problem drinking, but often underestimated it especially HIV providers.
Impact: These data support the expansion of routine screening for problem drinking already mandated in primary care to HIV clinics at the VA.