Purpose: To assess the impact of illicit drug use on health utilities for patients in HIV treatment.
Methods: We analyzed self-reported and clinical data for patients enrolled in the BHIVES collaborative, a multisite demonstration project in the U.S. that evaluated integrated treatment for opioid dependence and HIV at 10 HIV primary care sites from 2004-2009. We compared SF6D scores derived from SF-12 survey responses at baseline (N=307) and quarterly follow-up (N=782) visits by patient socio-demographics, illicit drug use (opiates/heroin, cocaine), immune status (CD4 cell count), alcohol use, opioid dependence treatment (buprenorphine or methadone), employment, housing status and study site. A multiple linear mixed effects model was specified to determine the effect of illicit drug use on health utility, adjusting for treatment status and other factors.
Results: The mean SF6D score was 0.65 (SD 0.14) across all visits. In univariate analysis, a lower score was associated with being female, age less than 30, being caucasian or Hispanic (versus black), use of heroin/opiates, cocaine use, drinking to intoxication, being homeless, and being unemployed (p-values<0.01). In multivariate analysis controlling for sex, age, and race/ethnicity, drug use (heroin/opiate and/or cocaine), being homeless and being unemployed were significantly associated with lower scores (Table). Drinking to intoxication, hepatitis C infection and immune status were not significantly associated with SF6D scores. Opioid dependence treatment was not significantly associated with SF6D scores after taking into account illicit drug use. Drug use did not statistically significantly modify the effect of opioid dependence treatment, housing status or employment status.
Impact on SF6D score of illicit drug use type in persons receiving HIV care
| ||
Estimate
| p-value
| |
Intercept
| 0.62
|
|
Cocaine use alone
| -0.04
| 0.06
|
Heroin/opiates use alone
| -0.05
| 0.01
|
Heroin/opiates and cocaine use
| -0.07
| <0.01
|
Homeless
| -0.03
| 0.03
|
Unemployed
| -0.08
| <0.01
|
Adjusted for age, sex, race/ ethnicity, immune status (CD4 cell count), hepatitis C infection status, and HIV care site
Conclusions: This population in HIV care with an opioid dependence diagnosis had low health utility, which was further reduced among those who were currently using illicit drugs. Reductions in health utility associated with homelessness and unemployment suggest that health utility in this population may benefit from interventions that address drug use and factors outside of the health care system.