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. 2018 Mar 20;18(1):366.
doi: 10.1186/s12889-018-5291-2.

Perceived access and barriers to care among illicit drug users and hazardous drinkers: findings from the Seek, Test, Treat, and Retain data harmonization initiative (STTR)

Mika Matsuzaki  1 , Quan M Vu  2 , Marya Gwadz  3 , Joseph A C Delaney  4 , Irene Kuo  5 , Maria Esther Perez Trejo  4 , William E Cunningham  6 , Chinazo O Cunningham  7 , Katerina Christopoulos  8
Affiliations

Perceived access and barriers to care among illicit drug users and hazardous drinkers: findings from the Seek, Test, Treat, and Retain data harmonization initiative (STTR)

Mika Matsuzaki et al. BMC Public Health. .

Abstract

Background: Illicit drug use (DU) and hazardous drinking (HD) among marginalized populations may be associated with greater barriers to care.

Methods: We used baseline data on the participants of the Seek, Test, Treat, and Retain data harmonization initiative. DU includes use of any illicit drugs within the past 6 months. HD was defined as scores ≥8 for men and ≥ 7 for women on Alcohol Use Disorders Identification Test within the past 12 months. Social support scores were assigned by summing scores from individual questions related to social support. Two outcomes for multivariable regression models and mediation analysis were perceived access to care and perceived barriers to care scores, calculated from summated points from individual questions within each domain. All models were adjusted for age, gender, race/ethnicity, and social support and stratified by HIV status.

Results: Among 1403 illicit drug users and 4984 non-drug users, the mean age was 39.6 ± 12.2 years old, 71% were male, 57% African Americans, and 39% Hispanic/Latinos. Over 25% reported difficulties in covering medical costs and finding transportation to health care facilities and greater proportions of drug users and hazardous drinkers reported these issues than non-DU/non-HD. In multivariable models, DU and HD were both independently associated with having greater barriers to care (β: 0.49 (95% confidence interval: 0.19 to 0.79) p < 0.01; 0.31 (0.18 to 0.45) < 0.01) in HIV-negative participants. Neither DU nor HD was strongly associated with barriers to care for HIV-positive participants. Social support was associated with better perceived access to care and fewer barriers to care in the HIV-negative participants.

Conclusion: The current study found that financial burdens of care, logistical difficulties in accessing care, and low social support were common challenges among individuals using illicit drugs and/or drinking hazardously. Addressing structural barriers and strengthening social support may be important strategies to improve health care among marginalized populations, regardless of HIV status.

Keywords: Barriers to care; HIV/AIDS; Race/ethnicity; Social support; Substance use.

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Conflict of interest statement

Ethics approval and consent to participate

All studies received approval from their respective Institutional Review Boards and, if applicable, Department of Corrections Research Advisory Committees. The ethics review boards that approved of the research were: the Institutional Review Board of the New York University School of Medicine (BCAP/BCU); the Maryland Department of Public Safety and Correctional Services Research Committee (BRIGHT2); the University of California San Francisco Committee on Human Research (C4C); the Albert Einstein College of Medicine Institutional Review Board (FIRST); the Institutional Review Board Columbia University Medical Center (STAR); Cook County Health & Hospitals Intuitional Review Board and University of Illinois at Chicago Institutional Review Board (STT COIP-Prison). All studies collected written informed consent. Additional protections were provided by the Office of Human Research Protections at the Department of Health and Human Services, and Certificates of Confidentiality were obtained. Our study is retrospective in nature.

Consent for publication

Not Applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Distribution of perceived access to care scores by HIV status and substance use patterns. Each box represents the 1st to 3rd quartiles with the median line. The jitter plots show the standardized score distributions. The mean values are marked as red dots and the values are noted under each boxplot. The whiskers indicated the lowest and highest values within 1.5 times 1st and 3rd quartile values. For this domain, higher standardized scores indicate better conditions
Fig. 2
Fig. 2
Distribution of perceived barriers to care scores by HIV status and substance use patterns. Each box represents the 1st to 3rd quartiles with the median line. The jitter plots show the standardized score distributions. The mean values are marked as red dots and the values are noted under each boxplot. The whiskers indicated the lowest and highest values within 1.5 times 1st and 3rd quartile values. For this domain, lower standardized scores indicate better conditions
See this image and copyright information in PMC

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