Persons living with HIV (PLWH) with substance use disorders (SUD) remain a population difficult to engage in HIV care. Project HOPE (Hospital Visits as an Opportunity for Prevention and Engagement), a randomized controlled trial testing patient navigation with/without contingency management for PLWH with SUD, aimed to address this disparity. PLWH with SUD who were out of care were recruited from 11 hospitals across the United States from 2012 to 2014. Baseline socioeconomic factors, medical mistrust scores, and perceived discrimination surveys were collected at enrollment and evaluated for effects on linkage to care at the 6-month follow-up assessment. Linkage to care (attending an outpatient visit for HIV care), early linkage to care (attending first visit within 30 days of enrollment), and engagement in care (two HIV visits within the 6-month period) were determined by medical record abstraction, supplemented by self-report. Among 801 participants enrolled in the study (mean age 45 years, 33% women, and 73% African American), those who did not complete high school and with severe food insecurity had lower odds of being linked to care at 6 months. Those with high levels of medical mistrust, recent drug use, and who did not complete high school had lower odds of early linkage to care. Early linkage was associated with higher odds of engagement at 6 months and was mitigated by both patient navigator interventions (all p < .05). Addressing social determinants of health is critical to correct the disparity seen in HIV outcomes among PLWH with SUD. Identifying factors that alter the effect of interventions could help identify patients who would benefit most.

中文翻译：

---

艾滋病毒感染者和同时发生的物质使用障碍的医疗服务联系不良的预测因素。

患有药物滥用疾病（SUD）的HIV感染者（PLWH）仍然难以进行HIV护理。HOPE项目（作为预防和参与机会的医院探视）是一项随机对照试验，对有/无SUD的PLWH进行应急管理的患者导航（有/没有应急管理），旨在解决这一差异。2012年至2014年间，从美国11家医院招募了患有SUD的PLWH处于失调状态的患者。在注册时收集了基线社会经济因素，医疗不信任感评分和感知的歧视调查，并在6-一个月的跟踪评估。与医疗机构的联系（参加艾滋病门诊门诊），与医疗机构的早期联系（在入院后30天内进行首次就诊），是否参与医疗保健（在6个月内两次HIV访视）取决于病历摘要，并附有自我报告。在参加该研究的801名参与者中（平均年龄45岁，女性占33％，非裔美国人占73％），那些没有完成高中学业且严重缺乏食物的人在​​6个月时获得护理的几率较低。那些医疗上不信任度高，最近吸毒并且没有完成高中课程的人，早期与护理联系的几率较低。早期联系与6个月参与的可能性更高有关，并且两种患者导航仪干预都减轻了联系（所有 那些没有读完高中和严重的粮食不安全的人，在六个月时获得护理的几率较低。那些医疗上不信任度高，最近吸毒并且没有完成高中课程的人，早期与护理联系的几率较低。早期联系与6个月参与的可能性更高有关，并且两种患者导航仪干预都减轻了联系（所有 那些没有读完高中和严重的粮食不安全的人，在六个月时获得护理的几率较低。那些医疗上不信任度高，最近吸毒并且没有完成高中课程的人，早期与护理联系的几率较低。早期联系与6个月参与的机会更高有关，并且两种患者导航仪干预都减轻了联系（所有p  <.05）。解决健康问题的社会决定因素对于纠正在SUD与PLWH之间艾滋病毒预后中出现的差异至关重要。确定改变干预效果的因素可以帮助确定最受益的患者。