Utilization of Mental Health and Substance Abuse Care for People Living With HIV/AIDS, Chronic Mental Illness, and Substance Abuse Disorders

Weaver, Marcia R.; Conover, Christopher J.; Proeschold‐Bell, Rae Jean; Arno, Peter S.; Ang, Alfonso; Ettner, Susan L.

doi:10.1097/qai.0b013e3181642244

Cited by 74 publications

(82 citation statements)

References 28 publications

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“…Despite the benefit of mental health treatment, research data from HCSUS and other studies report that a substantial proportion of HIV-infected individuals with mental illness are not receiving mental health care. 2,19,[33][34][35][36][37][38] For example, a study of individuals with HIV initiating mental health counseling found that nearly 30% did not return after 1 session and only 37% completed 6 counseling sessions. 37 Significant barriers to mental health treatment have been found for HIV-infected individuals including stigma, fear of discrimination, [39][40][41] travel distance to care, 37 and lack of education, 34,42 transportation, 43 insurance, 33,34 service availability, 44,45 and motivation.…”

Section: Introductionmentioning

confidence: 99%

In-Home Mental Health Treatment for Individuals with HIV

Reif

Pence

LeGrand

et al. 2012

AIDS Patient Care and STDs

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Mental health problems are highly prevalent among individuals with HIV and are consistently associated with negative health outcomes. However, mental illness often remains untreated due to significant psychosocial and physical barriers to treatment participation. The Collaborative HIV/AIDS Mental Health Program (CHAMP) assessed the outcomes associated with providing 9 months of in-home mental health counseling for 40 individuals with HIV and a Major Axis I mental disorder. The evidence-based Illness Management and Recovery Model was adapted for use with HIV-positive individuals for the study using a community-based participatory research approach. Study participants were surveyed at baseline, 5 and 9 months to assess for changes in health outcomes. Thirty-five percent of study participants were female, 80% African American, 33% self-identified as MSM and the average participant age was 43. Forty percent of participants were on psychotropic medication at baseline. Participants had an average of 8 counseling visits (median 9). Statistically significant decreases in the global Brief Symptom Inventory (BSI) score and a number of BSI symptoms dimensions including anxiety, depression, obsessive compulsive, phobic anxiety and hostility were detected, indicating a reduction of psychiatric symptoms. Statistically significant improvement was also identified for the SF-12 mental health scale, adaptive coping, overall social support and emotional support. No differences in psychiatric outcomes were identified by gender, race/ethnicity, or sexual preference. Findings from the CHAMP Study suggest that the use of in-home mental health treatment may be beneficial in engaging and treating HIV-positive individuals with comorbid mental health disorders.

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Section: Introductionmentioning

confidence: 99%

In-Home Mental Health Treatment for Individuals with HIV

Reif

Pence

LeGrand

et al. 2012

AIDS Patient Care and STDs

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“…However, differences between intervention and control groups were not statistically significant for some of these measures in a number of the studies, especially in regards to patient's improvement in quality-of-life and in one study, the annual cost-savings of health services (Weaver et al 2009). It is nevertheless imperative to be cognizant of the diversity in integration approaches adopted and varying methodologies across the studies.…”

Section: Implications For Researchmentioning

confidence: 99%

“…The percentage attributable to hospital care in both groups decreased, but there were no significant differences between them in annual cost of health services and quality of life. The overall risk of bias for this study was unclear (Weaver et al 2009). …”

Section: Meso-and Micro-level Integrationmentioning

confidence: 99%

“…From these papers, two distinct integration models were identified involving integration in a singlefacility and integration across multiple facilities. Twelve other Integrated care defined as mental health services provided on-site at the medical clinic Coleman et al 2012 Collaborative care defined by: (1) its guiding principles as described in The Chronic Care Model (CCM) which includes taking a team-based, patient-centered, collaborative approach that incorporates elements of patient care such as patient registries, patient education, screening or assessment tools, adherence monitoring, and evidence-based treatment guidelines; and (2) the degree of collaboration described as a continuum from less to more collaborative Weaver et al 2009 The merging of health and medical services conceptualized on a continuum of care ranging from coordinated, meaning that care is delivered in different settings with information sharing among programs; to co-located, meaning that services are delivered at one location; to integrated, meaning that medical and behavioral healthcare components are merged in one treatment plan Dodds et al 2004 Integrated service systems defined as multifaceted approaches to providing services for patients with complex needs, whereby two or more entities develop linkages to improve outcomes for their clients and combine efforts to serve clients more responsively. This means that providers from multiple disciplines share referrals, collaborate on case planning, and activate the resources of multiple agencies rather than constraining clients to a single agency or program papers described interventions that integrated services exclusively at the micro level through the use of case managers, serving as the 3 rd distinct model of integration identified.…”

Section: Levels Of Integrationmentioning

confidence: 99%

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Interventions and approaches to integrating HIV and mental health services: a systematic review

Haldane

Cervero-Liceras

Ong

et al. 2017

European Journal of Public Health

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Background: The frequency in which HIV and AIDS and mental health problems co-exist, and the complex bi-directional relationship between them, highlights the need for effective care models combining services for HIV and mental health. Here, we present a systematic review that synthesizes the literature on interventions and approaches integrating these services. Methods: This review was part of a larger systematic review on integration of services for HIV and non-communicable diseases. Eligible studies included those that described or evaluated an intervention or approach aimed at integrating HIV and mental health care. We searched multiple databases from inception until October 2015, independently screened articles identified for inclusion, conducted data extraction, and assessed evaluative papers for risk of bias. Results: Forty-five articles were eligible for this review. We identified three models of integration at the meso and micro levels: single-facility integration, multi-facility integration, and integrated care coordinated by a non-physician case manager. Single-site integration enhances multidisciplinary coordination and reduces access barriers for patients. However, the practicality and costeffectiveness of providing a full continuum of specialized care on-site for patients with complex needs is arguable. Integration based on a collaborative network of specialized agencies may serve those with multiple co-morbidities but fragmented and poorly coordinated care can pose barriers. Integrated care coordinated by a single case manager can enable continuity of care for patients but requires appropriate training and support for case managers. Involving patients as key actors in facilitating integration within their own treatment plan is a promising approach. Conclusion: This review identified much diversity in integration models combining HIV and mental health services, which are shown to have potential in yielding positive patient and service delivery outcomes when implemented within appropriate contexts. Our review revealed a lack of research in lowand middle-income countries, and was limited to most studies being descriptive. Overall, studies that seek to evaluate and compare integration models in terms of long-term outcomes and cost-effectiveness are needed, particularly at the health system level and in regions with high HIV and AIDS burden.

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“…19 Integration of mental health, substance use, and HIV care has been recommended for this population. 1,6,[20][21][22][23] A handful of studies have examined the integration of HIV prevention and treatment into substance use programs, 24,25 as well as integration of substance abuse assessment and interventions into HIV primary medical care. 21,26 More recent work has highlighted provider characteristics and their role in the integration of routine alcohol assessment and brief interventions in the HIV clinic.…”

Section: Introductionmentioning

confidence: 99%

A Cross-Site, Comparative Effectiveness Study of an Integrated HIV and Substance Use Treatment Program

Proeschold‐Bell

Heine

Pence

et al. 2010

AIDS Patient Care and STDs

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Co-occurrence of HIV and substance abuse is associated with poor outcomes for HIV-related health and substance use. Integration of substance use and medical care holds promise for HIV patients, yet few integrated treatment models have been reported. Most of the reported models lack data on treatment outcomes in diverse settings. This study examined the substance use outcomes of an integrated treatment model for patients with both HIV and substance use at three different clinics. Sites differed by type and degree of integration, with one integrated academic medical center, one co-located academic medical center, and one co-located community health center. Participants (n ¼ 286) received integrated substance use and HIV treatment for 12 months and were interviewed at 6-month intervals. We used linear generalized estimating equation regression analysis to examine changes in Addiction Severity Index (ASI) alcohol and drug severity scores. To test whether our treatment was differentially effective across sites, we compared a full model including site by time point interaction terms to a reduced model including only site fixed effects. Alcohol severity scores decreased significantly at 6 and 12 months. Drug severity scores decreased significantly at 12 months. Once baseline severity variation was incorporated into the model, there was no evidence of variation in alcohol or drug score changes by site. Substance use outcomes did not differ by age, gender, income, or race. This integrated treatment model offers an option for treating diverse patients with HIV and substance use in a variety of clinic settings. Studies with control groups are needed to confirm these findings.

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Utilization of Mental Health and Substance Abuse Care for People Living With HIV/AIDS, Chronic Mental Illness, and Substance Abuse Disorders

Abstract: Among adults with HIV/AIDS and co-occurring MH and SA disorders, utilization of MH and SA services needs to be improved.

Cited by 74 publications

References 28 publications

In-Home Mental Health Treatment for Individuals with HIV

In-Home Mental Health Treatment for Individuals with HIV

Interventions and approaches to integrating HIV and mental health services: a systematic review

A Cross-Site, Comparative Effectiveness Study of an Integrated HIV and Substance Use Treatment Program

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