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Chawla S, Kaida A, Brouillette MJ, Kleiner B, Dubuc D, Skerritt L, Burchell AN, Rouleau D, Loutfy M, de Pokomandy A. Mental health service use and shortages among a cohort of women living with HIV in Canada. BMC Health Serv Res 2024; 24:923. [PMID: 39135046 PMCID: PMC11321070 DOI: 10.1186/s12913-024-11396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The prevalence of mental health conditions among women with HIV in Canada ranges between 29.5% and 57.4%, highlighting the need for accessible mental health care. We aimed to (1) describe the availability and use of mental health services among women with HIV and (2) identify characteristics associated with reporting that shortages of these services presented a problem in their care. METHODS Baseline data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study were analysed. Self-reported availability and use of mental health services were examined using descriptive statistics. Participants indicated whether a lack of mental health support was a problem in their care. Logistic regression models were constructed to determine associations between sociodemographic, clinical, and psychosocial characteristics and reported problematic shortages. RESULTS Of 1422 women, 26.7% (n = 380) used mental health services in the last year, which most accessed through their HIV clinic. Thirty-eight percent (n = 541) reported that a shortage of mental health support was a problem in their care. Among this subset, 22.1% (n = 119) used services at their HIV clinic, 26.5% (n = 143) reported available services but did not use them, and 51.4% (n = 277) either indicated that these services were unavailable, did not know if such services were available, or were unengaged in HIV care. Factors associated with reporting problematic shortages included rural residence [adjusted odds ratio (aOR): 1.69, 95% confidence interval (CI): 1.03-2.77], higher education level (aOR: 1.43, 95% CI: 1.02-2.02), and higher HIV stigma score (aOR: 1.03, 95% CI: 1.02-1.03). Conversely, African/Caribbean/Black identity (aOR: 0.37, 95% CI: 0.26-0.54), history of recreational drug use (aOR: 0.56, 95% CI: 0.39-0.81), and Quebec residence (aOR: 0.69, 95% CI: 0.50-0.96) were associated with lower odds of reporting service shortages. CONCLUSION Our findings highlight the HIV clinic as the primary location of mental health service use. However, existing services may not be sufficient to reach all patients or meet specific needs. Furthermore, the low uptake among those reporting a shortage suggests a lack of connection to services or patient knowledge about their availability. Characteristics associated with reporting shortages reflect geographic and socioeconomic disparities that must be accounted for in future service design.
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Affiliation(s)
- Seerat Chawla
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Harvard Medical School, Boston, MA, USA
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Marie-Josée Brouillette
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Bluma Kleiner
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Danièle Dubuc
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Lashanda Skerritt
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Ann N Burchell
- MAP-Centre for Urban Health Solutions, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Danielle Rouleau
- Department of Microbiology, Infection and Immunology, University of Montreal, Montreal, QC, Canada
| | - Mona Loutfy
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, QC, Canada.
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
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Conteh NK, Latona A, Mahomed O. Mapping the effectiveness of integrating mental health in HIV programs: a scoping review. BMC Health Serv Res 2023; 23:396. [PMID: 37095471 PMCID: PMC10127013 DOI: 10.1186/s12913-023-09359-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Mental health and substance abuse issues are increasing among HIV-positive people, and it negatively impacts health outcomes like engagement, retention in HIV care, and adherence to ART. Thus, national ART programs must include mental health management. The scoping review sought to map evidence on the efficacy of combining HIV and mental health care. METHODS The Arksey and O'Malley methodological framework was used to map the existing research on integrating HIV and mental health services to identify knowledge gaps. Two independent reviewers screened articles for inclusion. Studies on HIV-mental health integration were considered. We searched numerous sources, extracted data, and summarized publications by integration model and patient outcomes. RESULTS Twenty-nine articles met the criteria for this scoping review. Twenty-three studies were from high-income countries, with only six from low and middle-income countries in Africa (Zimbabwe 1, Uganda 3, South Africa 1, and Tanzania 1). Most of the literature discussed single-facility integration although multi-facility and integrated care through a case manager was researched as well. There was a reduction in depression, alcohol use, increased social function, decreased self-reported stigma, decreased psychiatric symptoms, and improved mood in PLHIV who received cognitive behavioral therapy in settings implementing integrated care. When providing integrated mental health services to PLHIV, healthcare workers reported feeling more comfortable discussing mental illness. Personnel in the mental health field reported less stigma and increased PLHIV referrals for mental health services due to integrated HIV and mental health care. CONCLUSION According to the research, integrating mental health services into HIV care improves the diagnosis and treatment of depression and other mental disorders related to substance abuse in PLHIV.
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Chuah FLH, Haldane VE, Cervero-Liceras F, Ong SE, Sigfrid LA, Murphy G, Watt N, Balabanova D, Hogarth S, Maimaris W, Otero L, Buse K, McKee M, Piot P, Perel P, Legido-Quigley H. Interventions and approaches to integrating HIV and mental health services: a systematic review. Health Policy Plan 2017; 32:iv27-iv47. [PMID: 29106512 PMCID: PMC5886062 DOI: 10.1093/heapol/czw169] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 01/20/2023] Open
Abstract
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 cost-effectiveness 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 low- and 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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Affiliation(s)
- Fiona Leh Hoon Chuah
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Victoria Elizabeth Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Francisco Cervero-Liceras
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
| | - Louise A Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Georgina Murphy
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Nicola Watt
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Dina Balabanova
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Sue Hogarth
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
- London Borough of Waltham Forest, UK
| | - Will Maimaris
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
- Haringey Council, UK
| | - Laura Otero
- Nursing Section, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Kent Buse
- CIBER of Epidemiology and Public Health (CIBERESP-ISCIII), Madrid, Spain
| | - Martin McKee
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
| | - Pablo Perel
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
- The World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
- Centre for Global Non Communicable Diseases, London School of Hygiene & Tropical Medicine
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Watt N, Sigfrid L, Legido-Quigley H, Hogarth S, Maimaris W, Otero-García L, Perel P, Buse K, McKee M, Piot P, Balabanova D. Health systems facilitators and barriers to the integration of HIV and chronic disease services: a systematic review. Health Policy Plan 2017; 32:iv13-iv26. [PMID: 28666336 PMCID: PMC5886067 DOI: 10.1093/heapol/czw149] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 01/15/2023] Open
Abstract
Integration of services for patients with more than one diagnosed condition has intuitive appeal but it has been argued that the empirical evidence to support it is limited. We report the findings of a systematic review that sought to identify health system factors, extrinsic to the integration process, which either facilitated or hindered the integration of services for two common disorders, HIV and chronic non-communicable diseases. Findings were initially extracted and organized around a health system framework, followed by a thematic cross-cutting analysis and validation steps. Of the 150 articles included, 67% (n = 102) were from high-income countries. The articles explored integration with services for one or several chronic disorders, the most studied being alcohol or substance use disorders (47.7%), and mental health issues (29.5%). Four cross-cutting themes related to the health system were identified. The first and most common theme was the requirement for effective collaboration and coordination: formal and informal productive relationships throughout the system between providers and within teams, and between staff and patients. The second was the need for adequate and appropriately skilled and incentivized health workers-with the right expertise, training and operational support for the programme. The third was the need for supportive institutional structures and dedicated resources. The fourth was leadership in terms of political will, effective managerial oversight and organizational culture, indicating that actual implementation is as important as programme design. A fifth theme, outside the health system, but underpinning all aspects of the system operation, was that placing the patient at the centre of service delivery and responding holistically to their diverse needs. This was an important facilitator of integration. These findings confirm that integration processes in service delivery depend substantially for their success on characteristics of the health systems in which they are embedded.
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Affiliation(s)
- Nicola Watt
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Louise Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Dept. of Medicine, University of Oxford, Oxford, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Sue Hogarth
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Public Health Consultant at Tower Hamlets Together
| | - Will Maimaris
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Public Health Consultant, Haringey Council, London
| | - Laura Otero-García
- Nursing Section, Faculty of Medicine, Universidad Autonoma de Madrid, Arzobispo Morcillo Av., 4, Madrid and CIBER of Epidemiology and Public 15 Health (CIBERESP), Madrid, Spain
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Kent Buse
- Chief, Strategic Policy Directions, UNAIDS, Geneva, Switzerland
| | - Martin McKee
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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5
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Dodds S, Nuehring EM, Blaney NT, Blakley T, Lizzotte JM, Lopez M, Potter JE, O'Sullivan MJ. Integrating Mental Health Services into Primary HIV Care for Women: The Whole Life Project. Public Health Rep 2016; 119:48-59. [PMID: 15147649 PMCID: PMC1502259 DOI: 10.1177/003335490411900111] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The high rate of mental health problems in HIV-infected women jeopardizes the health of this vulnerable population, and constitutes a mandate for integrating mental health services into HIV primary care. The Whole Life project—a collaboration of the departments of Psychiatry and Obstetrics/Gynecology at the University of Miami School of Medicine—successfully integrated mental health services into primary HIV care for women. This article describes the conceptual framework of the integration, implementation strategies, effects of the service integration, and lessons learned. Funded by the Health Resources and Services Administration (HRSA) as a Special Program of National Significance (SPNS), Whole Life efforts have been sustained beyond the demonstration funding period as a result of the changes brought about in organizational structures, service delivery, and the providers' conceptualization of health for HIV-infected women.
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Affiliation(s)
- Sally Dodds
- Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Miami, FL 33101, USA.
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Kim S, Ades M, Pinho V, Cournos F, McKinnon K. Patterns of HIV and mental health service integration in New York State. AIDS Care 2014; 26:1027-31. [PMID: 24617706 DOI: 10.1080/09540121.2014.894613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Affordable Care Act (ACA) creates incentives to coordinate primary care, mental health (MH) care, and addiction services. Integration of clinical HIV and MH services has been shown to improve quality of life and physical and MH of people living with HIV/AIDS. However, few studies have investigated the practice of service integration systematically. We examined the practice patterns of 515 direct service providers in New York State who received training about HIV MH between May 2010 and July 2012. We sought to identify provider and treatment setting characteristics associated with an integrated spectrum of care. Using factor analysis and linear modeling, we found that patterns of service integration varied by type of health-care setting, service setting location, providers' HIV caseload, and the discipline of the provider describing the direct services. Understanding the existing capacities of clinicians providing care in a variety of settings throughout New York will help to guide staffing and linkage to enhance HIV MH service integration as significant shifts in the organization of health care occur.
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Affiliation(s)
- Sunhee Kim
- a College of Physicians and Surgeons , Columbia University , New York , NY , USA
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7
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Abstract
Chronic disease (care) management (CDM) is a patient-centered model of care that involves longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based care plans; and expert care availability. The model, incorporating mental health and specialty addiction care, holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care. We describe a CDM model for substance dependence and discuss a conceptual framework, the extensive current evidence for component elements, and a promising strategy to reorganize primary and specialty health care to facilitate access for people with substance dependence. The CDM model goes beyond integrated case management by a professional, colocation of services, and integrated medical and addiction care-elements that individually can improve outcomes. Supporting evidence is presented that: 1) substance dependence is a chronic disease requiring longitudinal care, although most patients with addictions receive no treatment (eg, detoxification only) or short-term interventions, and 2) for other chronic diseases requiring longitudinal care (eg, diabetes, congestive heart failure), CDM has been proven effective.
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8
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Winiarski MG, Beckett E, Salcedo J. Outcomes of an inner-city HIV mental health programme integrated with primary care and emphasizing cultural responsiveness. AIDS Care 2005; 17:747-56. [PMID: 16036261 DOI: 10.1080/09540120412331336733] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Effectiveness of HIV-related mental health practice in inner cities has not been adequately documented despite an urgent need for interventions for populations disproportionately affected by the epidemic. Practices must take into account and respond to cultural issues of people of colour and the needs of those infected through injection drug use or heterosexual sex with IDUs. We report the effectiveness of an HIV mental health programme integrated with primary care and emphasizing cultural responsiveness. A sample of 47 of 188 patients who received psychiatric and psychotherapy services was compared with other subjects. The 47 had an average of 8.34 encounters over an average of 36.23 weeks. Consumers of project services used mental health care at a higher rate than did comparison subjects. Regression analyses indicated that utilization was related to reduction in reported mental health problems, HIV-related physical symptoms, and use of alcohol and powdered cocaine, as well as to improvement in social functioning. Our clients, individuals often viewed as not likely to avail themselves of or benefit from mental health care, were highly motivated for self-improvement and, given access to competent, convenient and culturally respectful services, improved their well-being in significant domains.
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Affiliation(s)
- M G Winiarski
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
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9
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Abstract
With a significant proportion of HIV-infected patients now presenting with co-occurring substance abuse disorders and mental disorders, interest in integrated HIV care is growing. However, no review of integrated HIV care has been conducted. Using relevant key word searches of the Medline and Psychlit databases, the authors identified about 450 publications. The few evaluations of integrated models tended to focus on measurements of engagement and retention in medical care, and their findings indicated an association between integrated HIV care and increased service utilization. No random assignment controlled studies were identified, except in the peripheral area of integrated care (without HIV primary care) for persons with co-occurring substance abuse disorders and mental disorders. The majority of reviewed articles described integrated models operating in the field and various aspects of implementation and sustainability. Overall, they supported use of a wide range of primary and ancillary services delivered by a multidisciplinary team that employs a 'biopsychosocial' approach. Despite the lack of scientific knowledge regarding the effects of integrated HIV care, those wanting to optimize treatment for patients with multiple interacting disorders can gain useful and practical knowledge from this literature.
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Affiliation(s)
- T A Soto
- Cook County Bureau of Health Services/CORE Center, Chicago, IL, USA.
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10
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Pakenham KI, Dadds MR, Lennon HV. The efficacy of a psychosocial intervention for HIV/AIDS caregiving dyads and individual caregivers: a controlled treatment outcome study. AIDS Care 2002; 14:731-50. [PMID: 12511208 DOI: 10.1080/0954012021000081313] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The present study examined the comparative efficacy of intervening at the caregiver/care-recipient dyadic level, versus the individual caregiver level, for caregivers and their care-recipients with HIV/AIDS. Participants were randomly assigned to a Dyad Intervention (DI), a Caregiver Intervention (CI) or Wait List Control group (WLC), and assessed by interview and self-administered scales immediately before treatment and eight weeks later. Participants in the intervention groups also completed a four-month follow-up assessment. Dependent variables included global distress, social adjustment, dyadic adjustment, subjective health status, HIV/AIDS knowledge and target problem ratings. Results showed that caregivers in the DI group showed greater improvement from pre- to post-treatment on global distress, dyadic adjustment and target problems than the CI and WLC caregivers. The CI and DI caregivers showed greater improvement than the WLC group on all dependent variables except social adjustment. Care-recipients in the DI group improved significantly from pre- to post-treatment on dyadic adjustment, social adjustment, knowledge, subjective health status and Target Problem 1, whereas the CI and WLC care-recipients failed to improve on any of these measures. The treatment gains made by the DI caregivers and care-recipients on most dependent variables were maintained at a four-month follow-up. Findings support a reciprocal determinism approach to the process of dyadic adjustment and suggest that intervening at the caregiver/care-recipient level may produce better outcomes for both the caregiver and care-recipient than intervening at the individual caregiver level.
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11
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Flaskerud JH, Lee P. Vulnerability to health problems in female informal caregivers of persons with HIV/AIDS and age-related dementias. J Adv Nurs 2001; 33:60-8. [PMID: 11155109 DOI: 10.1046/j.1365-2648.2001.01638.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The health of informal caregivers is often studied from the perspective of caregivers' and care receivers' personal and interpersonal characteristics. This study offers an alternative explanation based on a vulnerable populations framework and considers the role of resource availability to the health status of informal caregivers (n=76). Caregivers in a convenience sample were females of diverse ethnicity and socioeconomic status, and care recipients were diagnosed with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) or age-related dementias (ARD). Personal interviews using structured instruments were conducted with caregivers who were attending outpatient clinics at a public hospital and a VA hospital. Instruments included the Center for Epidemiologic Studies Depression-Scale (CES-D), the Global Health Assessment (GHA), the Activities of Daily Living Scale (ADL), the Memory and Behavior Problems Checklist (MBPC) and items from the Symptom Checklist-90 (SCL-90) measuring anger, anxiety and loneliness. Caregivers were experiencing both physical and mental health problems. Regression analyses were used to examine the relationships among resources available to caregivers, conditions that put caregivers at risk for poorer health, and health status itself. Analyses were conducted for each group of caregivers separately (HIV and ARD) and for the total group, using depressive symptoms and perception of physical health as dependent variables. In caregivers of people with HIV/AIDS (PWHIV), caregiver distress over care recipient symptoms, anxiety and education were related to depressive symptoms. Depressive symptoms, anger and functional status of the PWHIV were related to caregivers' perception of poorer physical health. In caregivers of people with ARD, there were no significant predictors for depressive symptoms or perception of physical health. In the total group of caregivers, lower income and more anger were related to depressive symptom score. When perception of physical health was the dependent variable, minority ethnicity and depressive mood were related to worse perception of physical health. These findings support the relationship of a lack of resources to health status. A community-based programme of resources and health care services for the caregiver-care receiver dyad is recommended.
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Affiliation(s)
- J H Flaskerud
- UCLA School of Nursing, Los Angeles, California 90095-1702, USA.
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12
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Jenkins R, Strathdee G. The integration of mental health care with primary care. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2000; 23:277-291. [PMID: 10981272 DOI: 10.1016/s0160-2527(00)00037-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- R Jenkins
- WHO Collaborating Centre, Institute of Psychiatry, London, UK
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13
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Abstract
Ten models of adolescent human immunodeficiency virus (HIV) care were funded in 1993 by the Special Projects of National Significance (SPNS) Program, HIV/Acquired Immunodeficiency Virus (AIDS) Bureau, Health Resources and Services Administration, through the Ryan White CARE Act. These models were supported to advance knowledge about the engagement of HIV-positive and at-risk adolescents and young adults in care. This article provides an overview of the SPNS Program's adolescent initiative, which developed and evaluated innovative models of HIV care, and provides background information on and summarizes the 10 models of care. The models are organized into four groups emphasizing different concepts: (a) youth involvement; (b) outreach to bring youth into services; (c) case management and linkage to services; and (d) a comprehensive continuum of care for youth.
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Affiliation(s)
- E R Woods
- Division of Adolescent/Young Adult Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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14
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Woods ER, Samples CL, Melchiono MW, Keenan PM, Fox DJ, Chase LH, Tierney S, Price VA, Paradise JE, O'Brien RF, Mansfield CJ, Brooke RA, Allen D, Goodman E. Boston HAPPENS Program: a model of health care for HIV-positive, homeless, and at-risk youth. Human immunodeficiency virus (HIV) Adolescent Provider and Peer Education Network for Services. J Adolesc Health 1998; 23:37-48. [PMID: 9712252 DOI: 10.1016/s1054-139x(98)00048-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Boston HAPPENS [Human immunodeficiency virus (HIV) Adolescent Provider and Peer Education Network for Services] Program is a project supported by Special Projects of National Significance (SPNS) Program, HIV/AIDS Bureau, Health Resources and Services Administration, which provides a network of care for homeless, at-risk, and HIV-positive youth (ages 12-24 years), involving eight agencies. The program has provided services to 1301 youth, including 46 who are HIV-positive. Boston HAPPENS provides a citywide network of culturally and developmentally appropriate adolescent-specific care, including: (a) outreach and risk-reduction counseling through professional and adult-supervised peer staff, (b) access to appropriate HIV counseling and testing support services, (c) life management counseling (mental health intake and visits as part of health care and at times of crisis), (d) health status screening and services needs assessment, (e) client-focused, comprehensive, multidisciplinary care and support, (f) follow-up and outreach to ensure continuing care, and (g) integrated care and communication among providers in the metropolitan Boston area. This innovative network of youth-specific care offers a continuum from street outreach to referral and HIV specialty care that crosses institutional barriers.
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Affiliation(s)
- E R Woods
- Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, Massachusetts 02115, USA
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Meredith KL, Larson TA, Soons KR, Grace CJ, Fraser VJ, Mundy LM, Melchior LA, Huba GJ. Building comprehensive HIV/AIDS care services. AIDS Patient Care STDS 1998; 12:379-93. [PMID: 11361974 DOI: 10.1089/apc.1998.12.379] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This article presents the experiences of three innovative programs for HIV/AIDS-related health care funded by the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program. The Comprehensive Healthcare projects were funded as part of a larger initiative for innovative HIV service delivery models, consisting of 27 grantees, the funding agency (HRSA), and an Evaluation and Dissemination Center. These projects--the University of Nevada School of Medicine's Early Nutrition Intervention in HIV and AIDS project, the University of Vermont and State Agricultural College's Rural HIV Service Delivery project, and Washington University School of Medicine's Helena Hatch Special Care Center for Women--have developed specialized medical care models within the context of a continuum of services in a medical clinic. This article serves to describe the initial experiences of these three service demonstration projects, and some of the lessons learned as a result of their implementation. All of these projects share the goal of providing integrated services, such as medical care, nutrition, case management, and social and mental health services to people living with HIV/AIDS. However, the projects target different populations, (e.g., those in rural areas versus those in a large inner city), and use contrasting service delivery models of comprehensive HIV care. These projects have undertaken diverse activities and have used numerous effective strategies to increase their ability to provide a continuum of care and services for people living with HIV/AIDS. Based on the valuable lessons that the Comprehensive Healthcare projects learned during the first 2 years of funding, a number of collective recommendations have been made. It is expected that these suggestions will prove extremely useful to other programs that consider offering comprehensive health-care services to people living with HIV/AIDS or other complex medical conditions.
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Affiliation(s)
- K L Meredith
- Washington University School of Medicine, St. Louis, Missouri, USA
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Affiliation(s)
- J Fontanesi
- Department of Pediatrics, Kaiser Permanente Hospital, San Diego, CA, USA
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Lavoie SR, Kaplowitz LG. THE CONCEPT OF AN AIDS CENTER AND FAMILY-ORIENTED CARE. Immunol Allergy Clin North Am 1995. [DOI: 10.1016/s0889-8561(22)00844-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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