Low Rates of HIV Screening among Veterans with Substance Use Disorders
Screening for HIV in individuals with drug and alcohol use disorders is a longstanding and broadly endorsed quality of care recommendation. Most studies examining HIV screening rates among substance users have been in relatively small or geographically limited samples, and few have focused on screening patients with alcohol use disorders. This retrospective study sought to determine the rate of HIV screening among Veterans with substance use disorders. Using VA data, investigators identified more than 370,000 Veterans with a history of substance use disorders who also used VA healthcare services, defined as at least one inpatient or outpatient care visit, from 6/04 through 5/05. Investigators also assessed HIV screening, adjusting for patient demographics, health insurance, and important comorbid disease (e.g., hepatitis B and C).
Findings show that among the 371,749 Veterans with substance use disorders in this study, only 20% had evidence of ever having been screened for HIV. HIV screening was lowest among Veterans with alcohol use disorders alone (11%), and highest among Veterans treated in substance use programs (28%) or receiving inpatient care (28%). In this study cohort, the two most common disorders were alcohol use (96%) and cocaine use (36%). The majority of Veterans in this study had no health insurance (71%), and almost one-quarter (22%) had hepatitis C. Authors suggest that these findings support the need for more widespread interventions to expand routine voluntary HIV screening nationally — within and outside VA.
Dookeran N, Burgess J, Bowman C, Goetz M, Asch S, and Gifford A. HIV screening among substance abusing Veterans in care. Journal of Substance Abuse Treatment October 2009;37(3):286-291.
This study was partly funded by VA/HSR&D's HIV/Hepatitis Quality Enhancement Research Initiative (QUERI). Drs. Goetz, Asch, and Gifford are part of HIV/Hepatitis QUERI. Drs. Dookeran and Gifford are part of HSR&D's Center for Health Quality, Outcomes & Economic Research in Bedford, MA. Dr. Burgess is part of HSR&D's Center for Organization, Leadership and Management Research in Boston, MA.