Interventions for Integrating Behavioral Health Services Into HIV Clinical Care: A Narrative Review

Abstract

The integration of behavioral health services within HIV care settings holds promise for improving substance use, mental health, and HIV-related health outcomes for people with HIV. As part of an initiative funded by the Health Resources and Services Administration’s HIV/AIDS Bureau, we conducted a narrative review of interventions focused on behavioral health integration in HIV care in the U.S. Our literature search yielded 19 intervention studies published between 2010 and 2021. We categorized the interventions under six approaches: collaborative care; screening, brief intervention, and referral to treatment; patient reported outcomes; onsite psychological consultation; integration of addictions specialists; and integration of buprenorphine/naloxone treatment. All intervention approaches appeared feasible to implement in diverse HIV care settings and most showed improvements in behavioral health outcomes; however, measurement of HIV outcomes was limited. Future research studies of behavioral health integration interventions should evaluate HIV outcomes and assess facilitators and barriers to intervention uptake.

Detectable viral load associated with unmet mental health and substance use needs among trans women living with HIV in San Francisco, California

“…Minority stress from racial and anti-trans stigma on top of HIV stigma may exacerbate psychological distress while also reducing help-seeking for mental health support [ 34 ]. From a systems perspective, a key component to ensure success of integrated and culturally tailored substance use and mental health treatment is screening and referral [ 35 ]. We found that referrals for trans women with indicators of mental distress were low, suggesting that screening protocols may not be in place for behavioral health needs.…”

“…Despite these limitations, we did identify a need for interventions to improve behavioral health engagement among trans women living with HIV with a focus on mitigating health inequities within the population. Integration of outpatient substance use services and low threshold mental health services into HIV care may improve engagement [ 35 , 49 ]. Promising examples are emerging from the integration of opioid agonist treatment (OAT) services that are embedded within HIV care.…”

Provider perspectives on screening and treatment for opioid use disorder and mental health in HIV care: A qualitative study

“…The first step toward integration of mental health and OUD treatment in HIV care is effective, universal screening of these conditions at every HIV care appointment [ 25 ]. However, several barriers to screening and integration have been identified, including lack of provider awareness and time and resource constraints [ 28 , 29 ]. A systematic review identified six studies examining the integration of treatment for OUD in HIV care settings, five of which focused on MAT and one of which offered counseling only [ 27 ].…”

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“…The first step toward integration of mental health and OUD treatment in HIV care is effective, universal screening of these conditions at every HIV care appointment [25]. However, several barriers to screening and integration have been identified, including lack of provider awareness and time and resource constraints [28,29]. A systematic review identified six studies examining the integration of treatment for OUD in HIV care settings, five of which focused on MAT and one of which offered counseling only [27].…”