Utilization of mental health and substance abuse care for people living with HIV/AIDS, chronic mental illness, and substance abuse disorders. Journal of Acquired Immune Deficiency Syndromes, 47, 449-458

Department of Health Services, University of Washington, Seattle, WA, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.39). 05/2008; 47(4):449-58. DOI: 10.1097/QAI.0b013e3181642244
Source: PubMed

ABSTRACT To examine the effects of race/ethnicity, insurance, and type of substance abuse (SA) diagnosis on utilization of mental health (MH) and SA services among triply diagnosed adults with HIV/AIDS and co-occurring mental illness (MI) and SA disorders.
Baseline (2000 to 2002) data from the HIV/AIDS Treatment Adherence, Health Outcomes, and Cost Study.
A multiyear cooperative agreement with 8 study sites in the United States. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was administered by trained interviewers to determine whether or not adults with HIV/AIDS had co-occurring MI and SA disorders.
Subjects were interviewed in person about their personal characteristics and utilization of MH and SA services in the prior 3 months. Data on HIV viral load were abstracted from their medical records.
Only 33% of study participants received concurrent treatment for MI and SA, despite meeting diagnostic criteria for both: 26% received only MH services, 15% received only SA services, and 26% received no services. In multinomial logistic analysis, concurrent utilization of MH and SA services was significantly lower among nonwhite and Hispanic participants as a group and among those who were not dependent on drugs and alcohol. Concurrent utilization was significantly higher for people with Veterans Affairs Civilian Health and Medical Program of the Uniformed Services (VA CHAMPUS) insurance coverage. Two-part models were estimated for MH outpatient visits and 3 SA services: (1) outpatient, (2) residential, and (3) self-help groups. Binary logistic regression was estimated for any use of psychiatric drugs. Nonwhites and Hispanics as a group were less likely to use 3 of the 5 services; they were more likely to attend SA self-help groups. Participants with insurance were significantly more likely to receive psychiatric medications and residential SA treatment. Those with Medicaid were more likely to receive MH outpatient services. Participants who were alcohol dependent but not drug dependent were significantly less likely to receive SA services than those with dual alcohol and drug dependence.
Among adults with HIV/AIDS and co-occurring MH and SA disorders, utilization of MH and SA services needs to be improved.

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    • "In another cross-sectional, multisite study of 803 PLWHA, subjects with AUDs (alcohol dependence) were significantly less likely to engage in drug treatment services (including outpatient clinics, self-help sessions or residential treatment programs). AUDs were not associated, however, with use of mental health services (Weaver et al., 2008) or receipt of PCP prophylaxis, and other quality of care indicators (Cunningham et al., 2006). "
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    ABSTRACT: Alcohol use disorders (AUDs) are highly prevalent and associated with non-adherence to antiretroviral therapy, decreased health care utilization and poor HIV treatment outcomes among HIV-infected individuals. To systematically review studies assessing the impact of AUDs on: (1) medication adherence, (2) health care utilization and (3) biological treatment outcomes among people living with HIV/AIDS (PLWHA). Six electronic databases and Google Scholar were queried for articles published in English, French and Spanish from 1988 to 2010. Selected references from primary articles were also examined. Selection criteria included: (1) AUD and adherence (N=20); (2) AUD and health services utilization (N=11); or (3) AUD with CD4 count or HIV-1 RNA treatment outcomes (N=10). Reviews, animal studies, non-peer reviewed documents and ongoing studies with unpublished data were excluded. Studies that did not differentiate HIV+ from HIV- status and those that did not distinguish between drug and alcohol use were also excluded. Data were extracted, appraised and summarized. Our findings consistently support an association between AUDs and decreased adherence to antiretroviral therapy and poor HIV treatment outcomes among HIV-infected individuals. Their effect on health care utilization, however, was variable.
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    ABSTRACT: Two decades of research has established a link between substance abuse and HIV/AIDS, often referred to as the twin epidemics.1,2 Additionally, substance abuse and mental disorders are often co-occurring conditions;3 persons with substance use disorders are at elevated risk for mental health disorders and vice versa. People infected with HIV/AIDS and having co-occurring mental health and substance abuse disorders face enormous difficulty in accessing treatment and they often fail to receive adequate treatment for one or more of their illnesses.4 People with triple diagnoses (substance abuse, mental health disorders, and HIV) represent a growing challenge to health care service providers. This is even more tenuous for racial/ethnic minorities who are disproportionately represented and impacted by these diseases. This chapter presents data on the prevalence of drug use, mental illness, and HIV/AIDS among racial/ethnic minorities; addresses the link between substance abuse and HIV/AIDS; the link between mental disorder and HIV; and examines the effectiveness of HIV risk reduction strategies for drug-using populations. Further, the chapter discusses mental health issues and the needs of HIV-positive substance abusers and sets forth optimal management strategies for engaging the dually and triply diagnosed in treatment. Focus will be placed on racial/ethnic minorities, particularly African Americans, where appropriate.
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