Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current HIV/AIDS Reports
Published in: Current HIV/AIDS Reports 1/2019

01-02-2019 | Care | Behavioral Bio-Medical Interface (JL Brown and RJ DiClemente, Section Editors)

Substance Use Screening in HIV Care Settings: a Review and Critique of the Literature

Authors: Anthony E. Hitch, Nicole K. Gause, Jennifer L. Brown

Published in: Current HIV/AIDS Reports | Issue 1/2019

Login to get access

Abstract

Purpose of Review

People living with human immunodeficiency virus/AIDS (PLWHA) experience high prevalence of substance use disorders (SUD). HIV care settings represent a unique opportunity to identify possible SUD, to provide SUD interventions, and to improve linkage to SUD treatment. The aims of this paper are to (a) review and critique the extant literature examining substance use screening approaches among PLWHA in HIV care settings and (b) provide recommendations for future clinical practice.

Recent Findings

Twenty-one peer-reviewed articles that examined substance screening approaches employed in HIV and other primary care settings were included in the review. There was limited literature reporting on the implementation and evaluation of substance use screening practices within HIV care settings, and methodological rigor varied across studies. Further, the use of validated substance use screening measures or incorporation of other substance use screening approaches (e.g., use of urine drug testing) within routine HIV care practice is limited. Strategies to implement routine substance use screening within HIV care and incorporate additional substance use assessment, brief interventions, and referral to specialty substance use treatment are discussed.

Summary

Use of self-report substance use screening measures using web- or computer-delivered approaches that can be integrated within electronic health record systems is particularly promising. HIV care practices should consider potential models to optimally screen and treat SUD. Co-location of HIV and SUD treatment services may be optimal; when co-located services are not possible, strategies to consistently provide brief intervention approaches and referrals to specialty SUD treatment are needed.
Literature
1.
2.
Galvan FH, Bing EG, Fleishman JA, London AS, Caetano R, Burnam MA, et al. The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV. J Stud Alcohol. 2002;63(2):179–86.CrossRefPubMed
3.
Skalski LM, Watt MH, MacFarlane JC, Proeschold-Bell RJ, Stout JE, Sikkema KJ. Mental health and substance use among patients in a North Carolina HIV clinic. N C Med J. 2015;76(3):148–55.PubMedPubMedCentral
4.
Substance Abuse and Mental Health Services Administration. The NSDUH report: HIV/AIDS and substance use. 2010.
5.
Hartzler B, Dombrowski JC, Crane HM, Eron JJ, Geng EH, Christopher Mathews W, et al. Prevalence and predictors of substance use disorders among HIV care enrollees in the United States. AIDS Behav. 2017;21(4):1138–48.CrossRefPubMedPubMedCentral
6.
Ompad DC, Giobazolia TT, Barton SC, Halkitis SN, Boone CA, Halkitis PN, et al. Drug use among HIV+ adults aged 50 and older: findings from the GOLD II study. AIDS Care. 2016;28(11):1373–7.CrossRefPubMedPubMedCentral
7.
Pacek LR, Harrell PT, Martins SS. Cigarette smoking and drug use among a nationally representative sample of HIV-positive individuals. Am J Addict. 2014;23(6):582–90.CrossRefPubMedPubMedCentral
8.
Gamarel KE, Brown L, Kahler CW, Fernandez MI, Bruce D, Nichols S. Prevalence and correlates of substance use among youth living with HIV in clinical settings. Drug Alcohol Depend. 2016;169:11–8.CrossRefPubMedPubMedCentral
9.
Kalichman SC, Washington C, Kegler C, Grebler T, Kalichman MO, Cherry C, et al. Continued substance use among people living with HIV–hepatitis-C co-infection and receiving antiretroviral therapy. Subst Use Misuse. 2015;50(12):1536–43.CrossRefPubMedPubMedCentral
10.
O’Cleirigh C, Magidson JF, Skeer MR, Mayer KH, Safren SA. Prevalence of psychiatric and substance abuse symptomatology among HIV-infected gay and bisexual men in HIV primary care. Psychosomatics. 2015;56(5):470–8.CrossRefPubMed
11.
Durvasula R, Miller TR. Substance abuse treatment in persons with HIV/AIDS: challenges in managing triple diagnosis. Behav Med. 2014;40(2):43–52.CrossRefPubMed
12.
Saag LA, Tamhane AR, Batey DS, Mugavero MJ, Eaton EF. Mental health service utilization is associated with retention in care among persons living with HIV at a university-affiliated HIV clinic. AIDS Res Ther. 2018;15:1–10.CrossRefPubMedPubMedCentral
13.
Burnett JC, Broz D, Spiller MW, Wejnert C, Paz-Bailey G. HIV infection and HIV-associated behaviors among persons who inject drugs—20 cities, United States, 2015. MMWR Morb Mortal Wkly Rep. 2018;67(1):23–8.CrossRefPubMedPubMedCentral
14.
Des Jarlais DC, Arasteh K, Perlis T, Hagan H, Abdul-Quader A, Heckathorn DD, et al. Convergence of HIV seroprevalence among injecting and non-injecting drug users in New York City. AIDS. 2007;21(2):231–5.CrossRefPubMed
15.
Bradley-Springer L. 100% HIV prevention: missed opportunities for injection drug users? J Assoc Nurses AIDS Care. 2015;26(5):503–5.CrossRefPubMed
16.
Morin S, Myers J, Shade S, Koester K, Maiorana A, Rose C. Predicting HIV transmission risk among HIV-infected patients seen in clinical settings. AIDS Behav. 2007;11(5):6–16.CrossRef
17.
Gorbach PM, Drumright LN, Javanbakht M, Pond SL, Woelk CH, Daar ES, et al. Antiretroviral drug resistance and risk behavior among recently HIV-infected men who have sex with men. J Acquir Immune Defic Syndr. 2008;47(5):639–43.CrossRefPubMedPubMedCentral
18.
Gerbi GB, Habtemariam T, Tameru B, Nganwa D, Robnett V. A comparative study of substance use before and after establishing HIV infection status among people living with HIV/AIDS. J Subst Abus. 2011;16(6):464–75.
19.
Khan MR, Berger A, Hemberg J, O’Neill A, Dyer TP, Smyrk K. Non-injection and injection drug use and STI/HIV risk in the United States: the degree to which sexual risk behaviors versus sex with an STI-infected partner account for infection transmission among drug users. AIDS Behav. 2013;17(3):1185–94.CrossRefPubMedPubMedCentral
20.
Swendsen J, Conway KP, Degenhardt L, Glantz M, Jin R, Merikangas KR, et al. Mental disorders as risk factors for substance use, abuse and dependence: results from the 10-year follow-up of the National Comorbidity Survey. Addiction. 2010;105(6):1117–28.CrossRefPubMedPubMedCentral
21.
Klinkenberg WD, Sacks S, for the Hiv/aids Treatment Adherence HO, Cost Study G. Mental disorders and drug abuse in persons living with HIV/AIDS. AIDS Care. 2004;16:22–42.CrossRef
22.
Stoff DM, Mitnick L, Kalichman S. Research issues in the multiple diagnoses of HIV/AIDS, mental illness and substance abuse. AIDS Care. 2004;16(Suppl 1):S1–5.PubMed
23.
Adams C, Zacharia S, Masters L, Coffey C, Catalan P. Mental health problems in people living with HIV: changes in the last two decades: the London experience 1990–2014. AIDS Care. 2016;28:56–9.CrossRefPubMedPubMedCentral
24.
Pence BW, Miller WC, Whetten K, Eron JJ, Gaynes BN. Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the Southeastern United States. J Acquir Immune Defic Syndr. 2006;42(3):298–306.CrossRefPubMed
25.
Walkup J, Blank MB, Gonzalez JS, Safren S, Schwartz R, Brown L, et al. The impact of mental health and substance abuse factors on HIV prevention and treatment. J Acquir Immune Defic Syndr. 2008;47:S15–S9.CrossRefPubMed
26.
Rezaei S, Taramian S, Kafie SM. Psychopathological dimensions in substance abusers with and without HIV/AIDS and healthy matched group. Addict Health. 2013;5(3–4):115.PubMedPubMedCentral
27.
Gamarel KE, Nichols S, Kahler CW, Westfall AO, Lally MA, Wilson CM. A cross-sectional study examining associations between substance use frequency, problematic use and STIs among youth living with HIV. Sex Transm Infect. 2017;169:11–8.
28.
DeLorenze GN, Weisner C, Tsai A-L, Satre DD, Quesenberry CP Jr. Excess mortality among HIV-infected patients diagnosed with substance use dependence or abuse receiving care in a fully integrated medical care program. Alcohol Clin Exp Res. 2011;35(2):203–10.CrossRefPubMed
29.
Keen LL, Khan M, Clifford L, Harrell PT, Latimer WW. Injection and non-injection drug use and infectious disease in Baltimore City: differences by race. Addict Behav. 2014;39(9):1325–8.CrossRefPubMedPubMedCentral
30.
Carrico AW. Substance use and HIV disease progression in the HAART era: implications for the primary prevention of HIV. Life Sci. 2011;88(21–22):940–7.CrossRefPubMed
31.
Kuchinad KE, Hutton HE, Monroe AK, Anderson G, Moore RD, Chander G. A qualitative study of barriers to and facilitators of optimal engagement in care among PLWH and substance use/misuse. BMC Res Notes. 2016;9:229.CrossRefPubMedPubMedCentral
32.
Colasanti J, Stahl N, Farber EW, Del Rio C, Armstrong WS. An exploratory study to assess individual and structural level barriers associated with poor retention and re-engagement in care among persons living with HIV/AIDS. J Acquir Immune Defic Syndr. 2017;74(Suppl 2):S113–S20.CrossRefPubMedPubMedCentral
33.
Gonzalez A, Barinas J, O’Cleirigh C. Substance use: impact on adherence and HIV medical treatment. Curr HIV/AIDS Rep. 2011;8(4):223–34.CrossRefPubMed
34.
Moore RD, Keruly JC, Chaisson RE. Differences in HIV disease progression by injecting drug use in HIV-infected persons in care. J Acquir Immune Defic Syndr. 2004;35(1):46–51.CrossRefPubMed
35.
Carrico AW, Johnson MO, Moskowitz JT, Neilands TB, Morin SF, Charlebois ED, et al. Affect regulation, stimulant use, and viral load among HIV-positive persons on anti-retroviral therapy. Psychosom Med. 2007;69(8):785–92.CrossRefPubMed
36.
Baum MK, Rafie C, Lai S, Sales S, Page B, Campa A. Crack-cocaine use accelerates HIV disease progression in a cohort of HIV-positive drug users. J Acquir Immune Defic Syndr. 2009;50(1):93–9.CrossRefPubMed
37.
Cook JA, Burke-Miller JK, Cohen MH, Cook RL, Vlahov D, Wilson TE, et al. Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women. AIDS. 2008;22(11):1355–63.CrossRefPubMed
38.
Kalichman SC. Co-occurrence of treatment nonadherence and continued HIV transmission risk behaviors: implications for positive prevention interventions. Psychosom Med. 2008;70(5):593–7.CrossRefPubMed
39.
Sobell LC, Sobell MB. Timeline follow-back: a technique for assessing self-reported alcohol consumption. In: Litten RZ, Allen JP, Litten RZ, Allen JP, editors. Measuring alcohol consumption: psychosocial and biochemical methods. Totowa: Humana Press; 1992. p. 41–72.CrossRef
40.
Rosenbaum A, Rabenhorst MM, Reddy MK, Fleming MT, Howells NL. A comparison of methods for collecting self-report data on sensitive topics. Violence Vict. 2006;21(4):461–71.CrossRefPubMed
41.
Messer LC, Quinlivan EB, Parnell H, Roytburd K, Adimora AA, Bowditch N, et al. Barriers and facilitators to testing, treatment entry, and engagement in care by HIV-positive women of color. AIDS Patient Care STDs. 2013;27(7):398–407.CrossRefPubMedPubMedCentral
42.
Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, et al. The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. Am J Public Health. 2015;105(2):e75–82.CrossRefPubMedPubMedCentral
43.
Beer L, Fagan JL, Valverde E, Bertolli J. Health-related beliefs and decisions about accessing HIV medical care among HIV-infected persons who are not receiving care. AIDS Patient Care STDs. 2009;23(9):785–92.CrossRefPubMed
44.
• Delker E, Aharonovich E, Hasin D. Interviewer-administered TLFB vs. self-administered computerized (A-CASI) drug use frequency questions: a comparison in HIV-infected drug users. Drug Alcohol Depend. 2016;161:29–35. The authors examined agreement between two substance use assessment modalities, interview-administered Timeline Follow-Back and self-administered ACASI in a sample of PLWHA . CrossRefPubMedPubMedCentral
45.
Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA. 1999;281:283–7.CrossRefPubMed
46.
• Fredericksen R, Crane PK, Tufano J, Ralston J, Schmidt S, Brown T, et al. Integrating a web-based, patient-administered assessment into primary care for HIV-infected adults. J AIDS HIV Res. 2012;4(2):47–55. The authors examined the feasiblity of a web-based, self-administered patient reported substance use assessment measure in an HIV care setting and identified factors associated with successful integration of the screening approach . CrossRefPubMedPubMedCentral
47.
Ewing JA. Detecting Alcoholism. The CAGE Questionnaire. J Am Med Assoc. 1984;252(14):1905–7.
48.
Metsch LR, Pereyra M, Colfax G, Dawson-Rose C, Cardenas G, McKirnan D, et al. HIV-positive patients’ discussion of alcohol use with their HIV primary care providers. Drug Alcohol Depend. 2008;95(1–2):37–44.CrossRefPubMed
49.
Malbergier A, Cardoso LRD, Amaral RA. Adolescent substance use and family problems. Cad Saude Publica. 2012;28(4):678–88.CrossRefPubMed
50.
Eyawo O, McGinnis KA, Justice AC, Fiellin DA, Hahn JA, Williams EC, et al. Alcohol and mortality: combining self-reported (AUDIT-C) and biomarker detected (PEth) alcohol measures among HIV infected and uninfected. J Acquir Immune Defic Syndr. 2018;77(2):135–43.PubMedPubMedCentral
51.
Littlefield A, Brown J, Diclemente R, Safonova P, Sales J, Rose E, et al. Phosphatidylethanol (PEth) as a biomarker of alcohol consumption in HIV-infected young Russian women: comparison to self-report assessments of alcohol use. AIDS Behav. 2017;21(7):1938–49.CrossRefPubMedPubMedCentral
52.
Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med. 2002;156(6):607–14.CrossRefPubMed
53.
Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, et al. Two brief alcohol-screening tests from the alcohol use disorders identification test (AUDIT): validation in a female veterans affairs patient population. Arch Intern Med. 2003;163(7):821–9.CrossRefPubMed
54.
Surah S, Kieran J, O’Dea S, Shiel C, Raffee S, Mulcahy F, et al. Use of the Alcohol Use Disorders Identification Test (AUDIT) to determine the prevalence of alcohol misuse among HIV-infected individuals. Int J STD AIDS. 2013;24(7):517–21.CrossRefPubMed
55.
The Alcohol, Smoking and Substance Abuse Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction (Abingdon, England). 2002;97(9):1183–94.
56.
Machado IK, Luz PM, Lake JE, Castro R, Velasque L, Clark JL, et al. Self-rated health and substance use among individuals in HIV care in Rio de Janeiro, Brazil: a cross-sectional study. Int J STD AIDS. 2017;28(12):1175–83.CrossRefPubMedPubMedCentral
57.
58.
Samet JH, Phillips SJ, Horton NJ, Traphagen ET, Freedberg KA. Detecting alcohol problems in HIV-infected patients: use of the CAGE questionnaire. AIDS Res Hum Retrovir. 2004;20(2):151–5.CrossRefPubMed
59.
Skinner HA. Drug abuse screening test. The Drug Abuse Screening Test 1982;7(4):363–71.
60.
Parsons JT, Starks TJ, Millar BM, Boonrai K, Marcotte D. Patterns of substance use among HIV-positive adults over 50: implications for treatment and medication adherence. Drug Alcohol Depend. 2014;139:33–40.CrossRefPubMedPubMedCentral
61.
Pence BW, Gaynes BN, Whetten K, Eron JJ Jr, Ryder RW, Miller WC. Validation of a brief screening instrument for substance abuse and mental illness in HIV-positive patients. J Acquir Immune Defic Syndr. 2005;40(4):434–44.CrossRefPubMed
62.
Whetten K, Reif S, Swartz M, Stevens R, Ostermann J, Hanisch L, et al. A brief mental health and substance abuse screener for persons with HIV. AIDS Patient Care STDs. 2005;19(2):89–99.CrossRefPubMed
63.
Valderas JM, Kotzeva A, Espallargues M, Guyatt G, Ferrans CE, Halyard MY, et al. The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res. 2008;17(2):179–93.CrossRefPubMed
64.
65.
Miller WR, Baca C, Compton WM, Ernst D, Manuel JK, Pringle B, et al. Addressing substance abuse in health care settings. Alcohol Clin Exp Res. 2006;30(2):292–302.CrossRefPubMed
66.
Saitz R, Alford DP, Bernstein J, Cheng DM, Samet J, Palfai T. Screening and brief intervention for unhealthy drug use in primary care settings: randomized clinical trials are needed. J Addict Med. 2010;4(3):123–30.CrossRefPubMedPubMedCentral
67.
Graham LJ, Davis AL, Cook PF, Weber M. Screening, brief intervention, and referral to treatment in a rural Ryan White Part C HIV clinic. AIDS Care. 2016;28(4):508–12.CrossRefPubMed
68.
Saitz R, Palfai TPA, Cheng DM, Alford DP, Bernstein JA, Lloyd-Travaglini CA, et al. Screening and brief intervention for drug use in primary care: the ASPIRE randomized clinical trial. JAMA. 2014;312(5):502–13.CrossRefPubMedPubMedCentral
69.
Humeniuk R, Ali R, Babor T, Souza-Formigoni MLO, de Lacerda RB, Ling W, et al. A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries. Addiction. 2012;107(5):957–66.CrossRefPubMed
70.
Savage CL, Sanchez M. Alcohol and substance use disorder screening, brief intervention, and referral to treatment among people living with HIV/AIDS. J Addict Nurs. 2016;27(3):214–7.CrossRefPubMed
71.
Dawson Rose C, Cuca YP, Kamitani E, Eng S, Zepf R, Draughon J, et al. Using interactive web-based screening, brief intervention and referral to treatment in an urban, safety-net HIV clinic. AIDS Behav. 2015;19(Suppl 2):186–93.CrossRefPubMed
72.
Cropsey KL, Hendricks PS, Jardin B, Clark CB, Katiyar N, Willig J, et al. A pilot study of screening, brief intervention, and referral for treatment (SBIRT) in non-treatment seeking smokers with HIV. Addict Behav. 2013;38(10):2541–6.CrossRefPubMedPubMedCentral
73.
Hasin DS, Aharonovich E, O’Leary A, Greenstein E, Pavlicova M, Arunajadai S, et al. Reducing heavy drinking in HIV primary care: a randomized trial of brief intervention, with and without technological enhancement. Addiction. 2013;108(7):1230–40.CrossRefPubMedPubMedCentral
74.
Aharonovich E, Greenstein E, O’Leary A, Johnston B, Seol SG, Hasin DS. HealthCall: technology-based extension of motivational interviewing to reduce non-injection drug use in HIV primary care patients—a pilot study. AIDS Care. 2012;24(12):1461–9.CrossRefPubMedPubMedCentral
75.
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(2011):383–94.CrossRefPubMed
Metadata
Title
Substance Use Screening in HIV Care Settings: a Review and Critique of the Literature
Authors
Anthony E. Hitch
Nicole K. Gause
Jennifer L. Brown
Publication date
01-02-2019
Publisher
Springer US
Published in
Current HIV/AIDS Reports / Issue 1/2019
Print ISSN: 1548-3568
Electronic ISSN: 1548-3576
DOI
https://doi.org/10.1007/s11904-019-00434-9

Other articles of this Issue 1/2019

Current HIV/AIDS Reports 1/2019 Go to the issue

Behavioral Bio-Medical Interface (JL Brown and RJ DiClemente, Section Editors)

Social Networks of Substance-Using Populations: Key Issues and Promising New Approaches for HIV

Behavioral Bio-Medical Interface (JL Brown and RJ DiClemente, Section Editors)

Physiological Changes from Violence-Induced Stress and Trauma Enhance HIV Susceptibility Among Women

Behavioral Bio-Medical Interface (JL Brown and RJ DiClemente, Section Editors)

Interventions to Reduce Drug Use Among Methamphetamine Users at Risk for HIV

Central Nervous System and Cognition (SS Spudich, Section Editor)

HIV Eradication Strategies: Implications for the Central Nervous System

Behavioral Bio-Medical Interface (JL Brown and RJ DiClemente, Section Editors)

The Association Between Marijuana Use and HIV Continuum of Care Outcomes: a Systematic Review

The Science of Prevention (JD Stekler and JM Baeten, Section Editors)

HIV Prevention Interventions for Adolescents
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits