Prior-Year Substance Use Disorders and Subsequent HIV Retention in Care Among Men Living with HIV Who Have Sex with Men.

Abstract

Substance use disorders (SUDs) and polysubstance use (defined as co-occurring SUDs involving two or more substances), precursors for high-risk behaviors among key populations like men who have sex with men (MSM), may significantly impede optimal engagement in the HIV care continuum. Leveraging 14 years of Electronic Health Record (EHR) data (2006-2020) from a retrospective population-based cohort in South Carolina, we fitted logistic GLMMs with patient-level random intercepts to estimate lagged associations between prior-year SUD diagnoses and subsequent-year retention in care among 5183 MSM living with HIV. HIV retention in care status was defined as having at least two VL/CD4 tests at least 90 days apart within 365 days. Our findings include the following: (1) Retention in care decreased between baseline (74%) and year 10 (49%); (2) Any prior-year SUD was significantly associated with decreased odds of subsequent-year retention in care (OR [95% CI] = 0.85 [0.75-0.96]); (3) In adjusted models, age was a strong independent predictor of retention in care, with a protective effect among older age groups aged 31-40 years (OR [95% CI]= 1.75 [1.44-2.11]), 41-50 years (OR [95% CI] = 2.04 [1.64-2.53]), 51-60 years (OR [95% CI] = 3.03 [2.15-4.27]), and over 60 (OR [95% CI] = 2.56 [1.36-4.83]); and (4) Prior-year substance-specific SUDs and polysubstance use were not significantly associated with subsequent-year retention in care, diminishing the significant effect observed when SUD was modeled as "any SUD". Results suggest that addressing substance use disorder, in particular among young MSM, is critical for coordinating efforts and informing policy decisions to improve HIV retention in care, an enduring challenge for Southeastern US states like South Carolina.