Mental health (MH) comorbidities reduce retention in care for persons living with HIV (PLWH) and are associated with poor health outcomes. Optimizing retention in primary care is vital, as poor retention is associated with delayed receipt of antiretroviral (ARV) therapy, ARV non-adherence, and poor health outcomes, including failure to suppress viral load, decreased CD4 counts, and clinically significant ARV drug resistance. We hypothesized that MH service utilization would be associated with improved retention in care for patients with HIV and MH comorbidities.
This is a retrospective analysis of PLWH initiating outpatient HIV health care at a university-affiliated HIV clinic between January 2007 and December 2013. We examined the association between MH service utilization and retention in care, the outcome of interest, using univariate and multivariable logistic regression.
Overall, 627 (84.4%) out of 743 patients were retained in care using the Health Resources & Services Administration HIV/AIDS Bureau (HRSA/HAB) metric. A multivariable model adjusted for several sociodemographic factors, MH comorbidities, and MH service utilization. The results suggest that lack of health insurance (public ORadj = 0.3, p < 0.01; no insurance ORadj = 0.4, p < 0.01) and ≥ 3 MH comorbidities (ORadj = 0.3, P = 0.01) were associated with decreased retention in care. Conversely, older age (> 45 years, ORadj. = 1.6, p = 0.14) and ≥ 3 MH service utilization visits (ORadj. = 6.8, p < 0.01) were associated with increased retention in care.
Even in the absence of documented MH comorbidities, improved retention in care was observed with increasing MH service utilization. In order to achieve the US-based National HIV/AIDS Strategy goal of 90% retention in care for PLWH, MH service utilization should be considered along with other evidence-based interventions to improve retention for PLWH newly engaged in care.
White House. National HIV/AIDS Strategy for the United States: Updated to 2020, 2015. https://www.hiv.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdf. Accessed 3 Dec 2017.
Centers for disease control and prevention. Selected national HIV prevention and care outcomes in the United States. 2017:2014–2016.
Berg MB, Safren SA, Mimiaga MJ, Grasso C, Boswell S, Mayer KH. Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic. AIDS Care. 2005;17(7):902–7. https://doi.org/10.1080/09540120500101658. CrossRefPubMed
Mugavero MJ, Amico KR, Westfall AO, et al. Early retention in HIV care and viral load suppression: implications for a test and treat approach to HIV prevention. J Acquir Immune Defic Syndr. 2012;59(1):86–93. https://doi.org/10.1097/QAI.0b013e318236f7d2. CrossRefPubMedPubMedCentral
Durvasula R, Miller TR. Substance abuse treatment in persons with HIV/AIDS: challenges in managing triple diagnosis. Behav Med. 2014;40(2):43–52. https://doi.org/10.1080/08964289.2013.866540. CrossRefPubMedPubMedCentral
Hasin DS, O’Brien CP, Auriacombe M, et al. DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry. 2013;170(8):834–51. https://doi.org/10.1176/appi.ajp.2013.12060782. CrossRefPubMedPubMedCentral
Do AN, Rosenberg ES, Sullivan PS, et al. Excess burden of depression among HIV-infected persons receiving medical care in the united states: data from the medical monitoring project and the behavioral risk factor surveillance system. PLoS ONE. 2014;9(3):e92842. https://doi.org/10.1371/journal.pone.0092842. CrossRefPubMedPubMedCentral
Chander G, Himelhoch S, Moore R. Substance abuse and psychiatric disorders in HIV-positive patients. Drugs. 2006;66(6):769–89. https://doi.org/10.2165/00003495-200666060-00004. CrossRefPubMed
Mugavero MJ, Westfall AO, Zinski A, et al. Measuring retention in HIV care: the elusive gold standard. J Acquir Immune Defic Syndr. 2012;61(5):574–80. https://doi.org/10.1097/QAI.0b013e318273762f. CrossRefPubMedPubMedCentral
Azar MM, Springer SA, Meyer JP, Altice FL. A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depend. 2010;112(3):178–93. https://doi.org/10.1016/j.drugalcdep.2010.06.014. CrossRefPubMedPubMedCentral
De Hert M, Correll CU, Bobes J, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10(1):52–77. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L361401218. Accessed 3 Dec 2017.
Flores D, Leblanc N, Barroso J. Enroling and retaining human immunodeficiency virus (HIV) patients in their care: a metasynthesis of qualitative studies. Int J Nurs Stud. 2016;62:126–36. https://doi.org/10.1016/j.ijnurstu.2016.07.016. CrossRefPubMedPubMedCentral
Emlet CA, Brennan DJ, Brennenstuhl S, Rueda S, Hart TA, Rourke SB. The impact of HIV-related stigma on older and younger adults living with HIV disease: does age matter? AIDS Care. 2015;27(4):520–8. https://doi.org/10.1080/09540121.2014.978734. CrossRefPubMed
Policy HB. Clarifications regarding clients eligible for private health insurance and coverage of services by Ryan White HIV/AIDS Program. http://hab.hrsa.gov/manageyourgrant/pinspals/pcn1304privateinsurance.pdf. Accessed 3 Dec 2017.
Compendium of evidence-based interventions and best practices for HIV prevention. Centers for disease control. Published 2015. http://www.cdc.gov/hiv/prevention/research/compendium/lrc/index.html. Accessed 5 Jan 2016.
Humeniuk R, Ali R, Babor TF, et al. Validation of the alcohol, smoking and substance involvement screening test (ASSIST). Addiction. 2008;103(6):1039–47. https://doi.org/10.1111/j.1360-0443.2007.02114.x. CrossRefPubMed
Thompson MA, Mugavero MJ, Amico KR, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Ann Intern Med. 2012;156(11):817–33, W-284–289. https://doi.org/10.7326/0003-4819-156-11-201206050-00419.
HRSA HAB. HIV/AIDS Bureau Revised Performance Measure Portfolio. 2015.
Manea L, Gilbody S, McMillan D. A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry. 2015;37(1):67–75. https://doi.org/10.1016/j.genhosppsych.2014.09.009. CrossRefPubMed
Edwards M, Quinlivan EB, Bess K, et al. Implementation of PHQ-9 depression screening for HIV-infected patients in a real-world setting. J Assoc Nurses AIDS Care. 2014;25(3):243–52. https://doi.org/10.1016/j.jana.2013.05.004. CrossRefPubMed
Eaton EF, Tamhane AR, Burkholder GA, Willig JH, Saag MS, Mugavero MJ. Unanticipated effects of new drug availability on antiretroviral durability: implications for comparative effectiveness research. Open forum Infect Dis. 2016;3(2):ofw109. https://doi.org/10.1093/ofid/ofw109. CrossRefPubMedPubMedCentral
Marcin JP, Schembri MS, He J, Romano PS. A population-based analysis of socioeconomic status and insurance status and their relationship with pediatric trauma hospitalization and mortality rates. Am J Public Health. 2003;93(3):461–6. https://doi.org/10.2105/AJPH.93.3.461. CrossRefPubMedPubMedCentral
Smith SA, Hasan AK, Binkley PF, Foraker RE. The impact of insurance and socioeconomic status on outcomes for patients with left ventricular assist devices. J Surg Res. 2014;191(2):302–8. https://doi.org/10.1016/j.jss.2014.05.004. CrossRefPubMedPubMedCentral
Allison PD. Logistic regression using SAS: theory and application. In: Institute S, editor. NC: Cary; 2003.
Katz MH, Cunningham WE, Fleishman JA, et al. Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons. Ann Intern Med. 2001;135(8_Part_1):557–65. https://doi.org/10.7326/0003-4819-135-8_Part_1-200110160-00006. CrossRefPubMed
- Mental health service utilization is associated with retention in care among persons living with HIV at a university-affiliated HIV clinic
Lauren A. Saag
Ashutosh R. Tamhane
D. Scott Batey
Michael J. Mugavero
Ellen F. Eaton
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II