Prevalence of Substance Use in an HIV Primary Care Safety Net Clinic: A Call for Screening.

Patients were recruited from a clinic waiting room, so the findings reflect people already engaged in HIV care and may not apply to patients who are not attending. The analysis used only participants who completed both self-report and urine testing, not all enrolled participants; the paper says the analysed subset did not differ demographically from the full enrolled sample. Urine screening was not confirmed by a reference laboratory method, and urine tests can have false positives, false negatives, and technical problems. Urine testing mostly detects recent use, so it cannot establish a substance use disorder or long-term use. The study did not ask whether participants were prescribed opioids or methadone, so some positive urine results could reflect treatment. It did not collect HIV exposure category, and the sample had high CD4+ T cell counts and viral suppression, so it may not generalise to other HIV clinic populations. It did not use a single-item binge drinking screener, so binge drinking was not reported. Participants were paid for urine samples, which may affect willingness to provide specimens compared with routine care.

The authors reported no real or perceived vested interests that could be construed as a conflict of interest.

Do not read these screening results as evidence that screening or brief intervention improves HIV care. This paper measured prevalence only; it did not test an intervention, and urine tests cannot diagnose a substance use disorder.