Quantifying Health Policy Impacts on Substance Use and Treatment among Women with and at Risk for HIV

A Longitudinal Multilevel Analysis Using Women’s Interagency HIV Study

Overview

This research will generate evidence on how health policies (e.g., medical and recreational marijuana laws, prescription drug monitoring programs) impact substance use and drug and alcohol treatment among women with and at risk of HIV in the United States, and elucidate the pathways through which these policies shape HIV viral suppression among women with HIV.

This research integrates participant-level data from the Women’s Interagency HIV Study with contextual data (e.g., Prescription Drug Abuse Policy System, Directory of Drug and Alcohol Abuse Treatment Programs) capturing the policy and health care access environments where these women live.

An understanding of how health policies impact women’s substance use and utilization of drug and alcohol treatment, and whether these relationships vary by HIV status, can inform future policy responses and structural interventions designed to reduce substance use and increase utilization of drug and alcohol treatment in women.

Background

Substance use (SU), including hazardous alcohol use, is common among women with HIV in the United States (US) and rates exceed those of the general female population.

Substance-using women with HIV are less likely to initiate and adhere to antiretroviral medications, which has important implications for morbidity, mortality, and HIV transmission. Drug and alcohol treatment mitigates these effects, but is underutilized. In addition, high-dose opioid pain therapy is prevalent among people with HIV, increasing their risk of prescription drug misuse.

Marijuana may serve as an alternative for opioid-based pain management, but marijuana’s effect on HIV clinical outcomes is unclear. Several policy initiatives have the potential to influence SU and drug and alcohol treatment in the US by: 1) curbing inappropriate prescribing practices for pain management (e.g.,prescription drug monitoring programs [PDMPs]); 2) increasing access to drug a nd alcohol treatment (e.g., health parity laws [HPLs]); and 3) legalizing marijuana use for medical purposes (e.g., medical marijuana laws [MMLs]).

Yet, little is known about how these health policies impact women with HIV. Studies suggest that these policies have benefits (e.g., HPLs associated with drug treatment). Others found negative or unintended consequences (e.g., MMLs associated with more alcohol, but less opioid use).

This K01 leverages participant level data from the NIH-funded Women’s Interagency HIV Study by integrating cohort data with contextual data (e.g., Prescription Drug Abuse Policy System) capturing the policy and health care access environments where these women live.

The proposed study will use a longitudinal, multilevel design to generate evidence on how health policies impact SU and drug and alcohol treatment among women with and without HIV in the US, and elucidate the pathways through which health policies shape HIV viral suppression among women with HIV.

To identify class-specific facilitators and barriers to suicide prevention for each subgroup utilizing CBPR. Guiding questions: What are subgroup perceptions of the severity of suicide problems? What are the barriers and facilitators for the development of prevention programs?

Goals

GOAL 1. Assess relationships between PDMPs and prescribed and non-prescribed opioid use over time, examining the modifying role of HIV status and race.

GOAL 2. Assess relationships between HPLs, access to drug and alcohol treatment, and treatment utilization over time, examining the modifying role of HIV status, health insurance, and patterns of SU.

GOAL 3. Assess relationships between MMLs, access to legalized marijuana, and marijuana use and hazardous drinking, examining the modifying role of HIV status and patterns of SU.

GOAL 4. Among women with HIV, assess the impact of PDMPS, HPLs, and MMLs on HIV viral suppression, examining the mediating or modifying role of SU and drug and alcohol treatment.

To accomplish these aims the applicant will receive training in:

  1. the epidemiology of SU
  2. empirical policy analysis
  3. advanced longitudinal multilevel analysis

This is done under the mentorship of Drs. Vivian Go (The University of North Carolina at Chapel Hill), Leo Beletsky (Northeastern University), Adaora Adimora (The University of North Carolina at Chapel Hill), Daniel Bauer (The University of North Carolina at Chapel Hill), Daniel Kim (Northeastern University), Renee Johnson (John Hopkins University), and Bridget Freisthler (Ohio State University).

These analyses will to inform future policy and structural interventions by generating causal evidence on how policies influence SU and alcohol and drug treatment over time among US women with and at risk of HIV.

Project Team

Danielle Haley Northeastern University

Danielle Haley
Principal Investigator
Northeastern University

Michael Williams - Northeastern University

Michael Williams
Doctoral Student
Northeastern University

Manjot Kaur

Manjot Kaur
Health Equity Intern
Northeastern University

Leo Beletsky

Leo Beletsky
Primary Mentor
Northeastern University

Daniel Kim

Daniel Kim
Co-Mentor
Northeastern University