Factors Associated With Treatment Initiation for Psychiatric and Substance Use Disorders Among Persons With HIV

Abstract

Objective Prior studies of individuals with HIV infection have found that accessing psychiatric and substance abuse treatment when needed can improve health and prolong life, yet little is known about factors associated with treatment initiation. Methods In a retrospective cohort design including individuals with HIV infection (≥14 years old) in an integrated health care system in Northern California, this study included 822 patients with a major psychiatric diagnosis and 1,624 with a substance use disorder diagnosis. Data were extracted from a regional HIV registry and computerized databases. Results Twenty-four percent (N=198) of study patients with psychiatric diagnoses and 15% (N=245) with substance abuse or dependence received one or more specialty care visits within 12 months of diagnosis. Among patients with a psychiatric diagnosis, significant predictors of visiting a psychiatry clinic included not having an AIDS diagnosis at baseline or before the study (p=.049), having a diagnosis of major depression (p=.013), having a diagnosis of bipolar disorder (p<.001), and receiving a psychiatric diagnosis in 1996 versus later years of the study (p<.01). Among patients with a substance use disorder, significant predictors of initiating substance abuse treatment included age <30 (p=.015) and being in the HIV transmission risk group of injection drug use (p<.001). Conclusions Clinical, diagnostic, and demographic factors were associated with specialty care treatment initiation in this sample of individuals with HIV infection and substance use or psychiatric disorders. Developing strategies to enhance treatment initiation has the potential to improve outcomes for individuals with HIV infection.

Implementation and Operational Research: Affordable Care Act Implementation in a California Health Care System Leads to Growth in HIV-Positive Patient Enrollment and Changes in Patient Characteristics

“…12,31 HIV patients included in the quantitative analysis for the pre-ACA era were newly enrolled in KPNC between 1/1/2012–12/31/2012, and were confirmed HIV-positive prior to or up to 6 months post-enrollment. Newly enrolled was defined as having no KPNC coverage in the 6 months prior to index date in the HIV registry.…”

Correlates of self-reported history of mental health help-seeking: a cross-sectional study among individuals with symptoms of a mental or substance use disorder initiating care for HIV in Cameroon

“…In settings where access to formal mental health care remains limited, help-seeking from informal sources is particularly common and could provide a bridge to more formalized, evidence-based care where necessary [29,30]. While barriers and facilitators of formal and informal mental health help and care-seeking have been identified in high-resource settings [26,27,[31][32][33][34], research from resource-constrained settings is scarce, particularly in populations substantially affected by MSDs such as PLWH [35]. Greater understanding of prior mental health help-seeking behaviors among PLWH with MSD symptoms can clarify which individuals with MSD symptoms have or have not sought help, where they typically turned for help, and who sought informal help but may have benefited from more formal care.…”

Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study

“…We examined factors associated with utilization as conceptualized by the Andersen model [ 20 , 21 ]. The model proposes that utilization is determined by predisposing (e.g., race/ethnicity and other demographic factors), need (e.g., HIV diagnoses) and enabling factors (e.g., benefit plan, enrollment through the Exchange) [ 22 , 23 ]. Controlling for demographic factors and ADAP participation, we expected that utilization would be higher and that HIV outcomes would be better among PWH with lower deductibles, and that enrollment via the Exchange also might have a positive effect on these outcomes.…”