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Daily Marijuana Use is Associated with Missed Clinic Appointments Among HIV-Infected Persons Engaged in HIV Care

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Abstract

We assessed the association between marijuana use and retention in HIV care through a retrospective cohort study of patients engaged in care at a large HIV clinic in 2011 and 2012. Two different retention outcomes were assessed: not meeting the Institute of Medicine’s (IOM) retention definition (≥2 provider visits ≥90 days apart in a calendar year) and no-show visits. Any marijuana use and frequency of marijuana use were obtained from a substance use screening questionnaire administered at each clinic visit. Modified Poisson regression was used to estimate risk ratios and 95% confidence intervals for the association between marijuana use and retention outcomes. Marijuana use was reported by 17% of 1791 patients and 21% were not retained (IOM definition). Marijuana use was not associated with the IOM retention outcome, but was associated with missing the next scheduled appointment. A non-linear dose–response was observed for frequency of marijuana use and missed visits, with daily users having the highest risk compared to non-users. Daily marijuana use had a negative impact on HIV clinic attendance. Further research is needed to elucidate the mechanisms by which marijuana use affects this outcome to inform targeted interventions.

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Acknowledgements

This study was supported by the National Institutes of Health-funded Tennessee Center for AIDS Research (P30-AI110527) and the National Institute on Drug Abuse at the National Institutes of Health (R03-DA039743 to A.M.K). Drs. Kipp and Brinkley-Rubinstein were scholars with the HIV/AIDS, Substance Abuse, and Trauma Training Program (HA-STTP), at the University of California, Los Angeles supported through an award from the National Institute on Drug Abuse at the National Institutes of Health (R25-DA035692). Dr. Brinkley-Rubinstein received additional support through training programs at Brown University funded by the National Institutes of Health (National Institute on Drug Abuse, T32-DA013911; and National Institute for Mental Health, R25-MH083620).

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Authors and Affiliations

  1. Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Aaron M. Kipp

  2. Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Peter F. Rebeiro, Megan Turner, Sally Bebawy, Timothy R. Sterling & Todd Hulgan

  3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Bryan E. Shepherd

  4. Institute for Community Health Promotion, School of Public Health, Brown University, Providence, RI, USA

    Lauren Brinkley-Rubinstein

  5. Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI, USA

    Lauren Brinkley-Rubinstein

  6. Vanderbilt Institute for Medicine and Public Health, 2525 West End Ave., Suite 614, Nashville, TN, 37203, USA

    Aaron M. Kipp

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  1. Aaron M. Kipp
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Correspondence to Aaron M. Kipp.

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All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was reviewed and approved by the Vanderbilt University medical Center Institutional Review Board.

Informed Consent

The informed consent process was waived by the Institutional Review Board because all data were collected as part of routine care and the study was a retrospective analysis of existing clinical data.

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Kipp, A.M., Rebeiro, P.F., Shepherd, B.E. et al. Daily Marijuana Use is Associated with Missed Clinic Appointments Among HIV-Infected Persons Engaged in HIV Care. AIDS Behav 21, 1996–2004 (2017). https://doi.org/10.1007/s10461-017-1716-7

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