Mental health service utilization is associated with retention in care among persons living with HIV at a university-affiliated HIV clinic

Saag, Lauren A.; Tamhane, Ashutosh; Batey, D. Scott; Mugavero, Michael J.; Eaton, Ellen

doi:10.1186/s12981-018-0188-9

Cited by 30 publications

(35 citation statements)

References 44 publications

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“…Our data demonstrated the effectiveness of third-line ART in a programme where the predominant subtype was C. Our findings are in line with other studies from the region that demonstrated good virological suppression rates among patients receiving third-line ART [11,12,23]. Findings from studies in resource limited settings have demonstrated that virologic suppression is a realistic endpoint for most treatment-experienced patients who begin a darunavir-based third-line therapy outside the controlled conditions of a randomized trial, at routine care settings [24][25][26].…”

Section: Plos Onesupporting

confidence: 91%

Zimbabwe’s national third-line antiretroviral therapy program: Cohort description and treatment outcomes

Chimbetete

Shamu²,

Keiser

2020

PLoS ONE

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Background In 2015, Zimbabwe introduced third-line antiretroviral therapy (ART) through four designated treatment centers; three government clinics in Harare and Bulawayo, and Newlands Clinic (NC), operated by a private voluntary organization in Harare. We describe characteristics of patients receiving third line ART and analyzed treatment outcomes in this national programme as of 31 December 2018. Methods We described the population using proportions for categorical variables, and medians and interquartile ranges for continuous variables. Patients from NC, where data were more complete, were followed from the date of starting third-line ART until death, transfer, loss to follow up or 31 December 2018. Results A total of 209 patients had ever received third-line ART: 124 at NC and 85 from the three government clinics. HIV genotype results were available for 89 (72%) patients at NC and fourteen (16.5%) patients in the government clinics. Median duration of third line ART (years) in the government clinics was 2.3 (IQR:0.6-3.4), 1.3 (IQR: 0.7-1.7) and 1 (0.6-1.9). Of the 67 patients who received third line ART in the government clinics for at least six months, 53 (79%) had most recent viral load (VL) < 1000 copies/ml. Data on other treatment outcomes from government clinics were incomplete. From NC: a total of 109 (88%) patients were still in care, 13 (10.5%) had died and 2 (1.5%) were transferred. Median duration of third-line ART was 1.4 years (IQR: 0.6-2.8). Among the 111 NC patients who had received third-line ART for at least 6 months, 83 (75%) had a VL <50 copies/ml and 106 (95.5%) had a VL <1000 copies/ml.

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Section: Plos Onesupporting

confidence: 91%

Zimbabwe’s national third-line antiretroviral therapy program: Cohort description and treatment outcomes

Chimbetete

Shamu²,

Keiser

2020

PLoS ONE

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“…Two-thirds of clients maintained engagement in HIV care before and after MH initiation. This is in contrast to a recent paper that demonstrated improved retention in care with more than 3 MH visits for PLWH who were newly initiating care and received a bundled intervention to improve retention in care [15]. Our study population differed, as the clients were not all newly initiating HIV medical care.…”

Section: Discussionmentioning

confidence: 62%

Expanded HIV Clinic–Based Mental Health Care Services: Association With Viral Suppression

Aggarwal

Pham

Dillingham

et al. 2019

Open Forum Infectious Diseases

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Background An academic Ryan White HIV/AIDS Program clinic increased co-located mental health care (MH) services in 2013. The study objectives were to characterize the changing demographics of the people living with HIV (PLWH) who initiated MH and to determine MH initiation’s association with HIV outcomes. Methods The cohort included PLWH who received clinic-based MH services from 2012 to 2014. Cohorts A and B initiated MH before or during 2012 and during 2013–2014, respectively. Demographics were compared for the 2 cohorts, and for Cohort B, pre/post–MH initiation clinical outcomes were compared. Results Compared with Cohort A (n = 130), Cohort B (n = 181) had 3 times the participants with CD4 counts <200 ( P = .02). One-third of Cohort B had detectable viral loads compared with <20% of Cohort A ( P = .01). Cohort B received more substance use diagnoses ( P = .005). Pre/post–MH initiation, engagement in care did not change. For Cohort B, MH initiation was associated with increased rates of viral suppression. For those who were prescribed antiretroviral therapy more than 1 year before MH initiation, participants who were older and nonblack were more likely to achieve viral suppression. Conclusions PLWH who gained access to MH in 2013–2014 were more likely to have lower CD4 counts and detectable viral loads. Engagement in care did not increase with initiation of MH, but initiation of MH was associated with higher rates of viral suppression. Younger and minority patients may not have benefited as much from increased access to co-located MH and substance use services.

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“…We also acknowledge that there is no gold standard method to measure retention and that a limitation of primary care visit adherence is that it does not account for the number of visits scheduled [35]. Furthermore, we could not assess the mediating effects of psychiatric disease, substance use, and stigma, which are not always well captured in the EMR but are likely factors in the causal pathway between HUH and acute care utilization [36, 37]. Lastly, there are limitations related to model calculations of incidence rate differences, particularly for non–normally distributed data, that may lead to inaccurate marginal rate estimations [38].…”

Section: Discussionmentioning

confidence: 99%

Housing Instability Results in Increased Acute Care Utilization in an Urban HIV Clinic Cohort

Clemenzi-Allen

Neuhaus

Geng

et al. 2019

Open Forum Infectious Diseases

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Background People living with HIV (PLWH) who experience homelessness and unstable housing (HUH) often have fragmented health care. Research that incorporates granular assessments of housing status and primary care visit adherence to understand patterns of acute care utilization can help pinpoint areas for intervention. Methods We collected self-reported living situation, categorized as stable (rent/own, hotel/single room occupancy), unstable (treatment/transitional program, staying with friends), or homeless (homeless shelter, outdoors/in vehicle) at an urban safety-net HIV clinic between February and August 2017 and abstracted demographic and clinical information from the medical record. Regression models evaluated the association of housing status on the frequency of acute care visits—urgent care (UC) visits, emergency department (ED) visits, and hospitalizations—and whether suboptimal primary care visit adherence (<75%) interacted with housing status on acute care visits. Results Among 1198 patients, 25% experienced HUH. In adjusted models, unstable housing resulted in a statistically significant increase in the incidence rate ratio for UC visits (incidence rate ratio [IRR], 1.35; 95% confidence interval [CI], 1.10 to 1.66; P < .001), ED visits (IRR, 2.12; 95% CI, 1.44 to 3.13; P < .001), and hospitalizations (IRR, 1.75; 95% CI, 1.10 to 2.77; P = 0.018). Homelessness led to even greater increases in UC visits (IRR, 1.75; 95% CI, 1.29 to 2.39; P < .001), ED visits (IRR, 4.18; 95% CI, 2.77 to 6.30; P < .001), and hospitalizations (IRR, 3.18; 95% CI, 2.03 to 4.97; P < .001). Suboptimal visit adherence differentially impacted UC and ED visits by housing status, suggesting interaction. Conclusions Increased acute care visit frequency among HUH-PLWH suggests that interventions at these visits may create opportunities to improve care.

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Mental health service utilization is associated with retention in care among persons living with HIV at a university-affiliated HIV clinic

Cited by 30 publications

References 44 publications

Zimbabwe’s national third-line antiretroviral therapy program: Cohort description and treatment outcomes

Zimbabwe’s national third-line antiretroviral therapy program: Cohort description and treatment outcomes

Expanded HIV Clinic–Based Mental Health Care Services: Association With Viral Suppression

Housing Instability Results in Increased Acute Care Utilization in an Urban HIV Clinic Cohort

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