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Among 2,059 people with HIV aged 40 years or older across eight IeDEA clinics (2020 to 2022), we examined what self-reported AOD use (AUDIT, ASSIST) and POC urine tests (uEtG for alcohol; 5-panel drug screen) each capture. Self-report identified more use than urine testing (unhealthy alcohol 19.7% versus uEtG-positive 12.2%), consistent with its longer recall window. Higher self-reported alcohol intensity was associated with uEtG positivity in a graded pattern, more strongly among women. Urine-positive but self-report-negative results, more common among men, suggested under-reporting. Self-report and biomarkers answer different measurement questions: self-report for longer-term burden and screening, biomarkers for recent use and corroboration. Combining both, including longer-window biomarkers, can strengthen AOD measurement among older PWH in LMICs.<\/jats:p>","DOI":"10.1007\/s10461-026-05270-8","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T09:15:08Z","timestamp":1788426908000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Self-reported and Point-of-Care Biomarkers of Substance Use Measures Among Older Adults with HIV from Low- and Middle-Income Countries"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2389-6973","authenticated-orcid":false,"given":"Kathryn E.","family":"Lancaster","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa A.","family":"Stockton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith 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