Many patients with HIV receive care for neuropsychiatric disorders in HIV primary care clinics. This is at least partially due to a shortage of mental health specialists, which leads to long wait times and inadequate continuity of care. Stigma of mental illness can also be a major barrier to people seeking psychiatric care in mental health settings. In people with HIV, the stigma of mental illness is compounded by that of having HIV. Patients frequently fear discrimination and rejection and may avoid leaving HIV primary care settings to seek treatment in other settings. As a consequence, there is a need to provide psychiatric care in a setting that is accessible to, acceptable to, and supportive of the patient. Such a need also offers a tremendous opportunity to provide integrated biopsychosocial approaches to treat the whole patient with HIV.There are several integrated care models by which psychiatric care can be provided to patients with HIV. Integrated models of care for HIV psychiatry refer to a psychiatrist specializing in HIV psychiatry working closely with patients and other physicians to provide coordinated care for complex patients with HIV. Rarely is any model implemented in "complete" form. Rather, implementing integrated care involves local adaptations, based on availability of clinical resources, acceptability in existing clinic culture, and additions of clinical resources to address gaps in treatment. Integration occurs on a continuum, often starting with small changes and building on gains. Successful integration efforts capitalize on the strengths of team members and structure, occur in stages, and allow for revision based on feedback from clinicians and patients. Maintaining a dialogue among those who are developing and are impacted by integrated care programs is essential. Input from all stakeholders impacted by healthcare integration is important to make the organizational changes necessary to properly implement an integrated care system.Telepsychiatry is a useful technology to improve patients' access to psychiatric care and can be leveraged in any of the integrated care models [5]. It can enhance communication among clinical team members working at different sites. It can also be used to provide education and "curbside consultation" to HIV clinicians.In this chapter, we describe four models of integrated care that can be applied to HIV psychiatry: the consultation and referral model, the co-located model, the patient-centered medical home (PCMH), and the collaborative care model. Within our discussion of collaborative care, we describe key components, summarize the evidence base for collaborative care, list roles of key members of the collaborative care team, and identify essential areas of workforce training. We detail a systematic approach to screening, diagnosis, treatment, and monitoring. Some of the complexities of providing collaborative care for HIV, including stigma, isolation, and high rates of neuropsychiatric comorbidities, will be illustrated via patient cases.
