Concordance between self-reported substance use and toxicology among HIV-infected and uninfected at risk youth

Abstract

Background Substance use by youth living with HIV (YLWH) is a concern, given potential interactions with virus-associated immune suppression and adverse effects on risk behaviors, neurocognition, and adherence. Self-report substance use measures provide efficient cost-effective assessments. Analyses describe self-reported substance use among YLWH and examine agreement with toxicology assays. Methods Seventy-eight youth age 18–24 years (87% male, 71% African–American) with behaviorally acquired HIV-1 infection and 55 uninfected youth completed the Alcohol, Smoking, and Substance Involvement Screening Test to assess drug use frequency, including tobacco, marijuana, cocaine, and alcohol, over the prior three months. Elisa-based toxicology assays were used to detect 27 substances in plasma. Chi-square tests compared substance use between YLWH and uninfected youth; Kappa statistics compared agreement between self-report and toxicology. Results YLWH reported marijuana (49%), tobacco (56%), and alcohol (87%) use, with 20%, 28% and 3% reporting daily use of each substance, respectively; other substance use was uncommon. Uninfected youth reported less tobacco use but otherwise similar substance use. All youth who reported daily use of marijuana or tobacco had positive plasma toxicology results, while concordance decreased with less frequent self-reported use. Among youth reporting no substance use, few tested positive (4% YLWH, 2% uninfected youth for cannabis; 8%YLWH for tobacco). Conclusions Youth report high rates of marijuana, tobacco, and alcohol use. Concordance between self-report and toxicology for marijuana and tobacco use, particularly for daily users, supports self-report as a valid indicator of substance use in research studies of youth with or without HIV-1 infection.

A cross-sectional study examining associations between substance use frequency, problematic use and STIs among youth living with HIV

“…In this sample of YLWH, we found a high incidence of STI diagnoses with estimates similar to those found in samples of adults living with HIV 21. Routine STI screening has been recommended for all sexually active individuals, including adolescents,18 21 23 and has been implemented in many HIV clinics in the USA.…”

“…Although ACASI technology was used to reduce social desirability bias, substance use data were based on self-report and there may be social desirability and recall bias. However, previous studies have found strong associations between self-report and substance use 21. We were only able to collect substance use information at one time point, which limits our ability to determine whether substance use is causally related to STI diagnoses.…”

Profiles of Risk Among HIV-Infected Youth in Clinic Settings

“…Although the majority of data were collected via self-report, we used computer assisted self-interviews which have been demonstrated to increase the reliability and validity of self-report data [52]. One recent study in the ATN found that the use of computer assisted self-reporting of drug use had high rates of concordance with toxicology results in youth with HIV infection [53]. Our participants had at least one clinical care visit during the study period; youth with undiagnosed HIV infection or otherwise not engaged in the medical system are not represented in our sample.…”

Psychological Symptoms Among 2032 Youth Living with HIV: A Multisite Study

“…One recent study in the ATN found that the use of computer assisted self-reporting of drug use had high rates of concordance with toxicology results in youth with HIV infection. 46 Finally, all participants are currently receiving some type of medical or psychosocial care through adolescent medical care clinics. Thus, youth with HIV infection who are not engaged in the medical system are not represented in this sample.…”