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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Bryant H, Bourdeau B, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for Integrating Behavioral Health Services into HIV Clinical Care: A Narrative Review. Open Forum Infect Dis 2022; 9:ofac365. [PMID: 35967264 PMCID: PMC9364372 DOI: 10.1093/ofid/ofac365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
The integration of behavioral health services within human immunodeficiency virus (HIV) care settings holds promise for improving substance use, mental health, and HIV-related health outcomes for people with HIV. As part of an initiative funded by the Health Resources and Services Administration’s HIV/AIDS Bureau, we conducted a narrative review of interventions focused on behavioral health integration (BHI) in HIV care in the United States (US). Our literature search yielded 19 intervention studies published between 2010 and 2021. We categorized the interventions under 6 approaches: collaborative care; screening, brief intervention, and referral to treatment (SBIRT); patient-reported outcomes (PROs); onsite psychological consultation; integration of addiction specialists; and integration of buprenorphine/naloxone (BUP/NX) treatment. All intervention approaches appeared feasible to implement in diverse HIV care settings and most showed improvements in behavioral health outcomes; however, measurement of HIV outcomes was limited. Future research studies of BHI interventions should evaluate HIV outcomes and assess facilitators and barriers to intervention uptake.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Boston University School of Public Health , Boston, MA , USA
- Bouve College of Health Sciences, Northeastern University , Boston, MA , USA
| | | | - Beth Bourdeau
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco , San Francisco, CA , USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
- Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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Binagwaho A, Fawzi MCS, Agbonyitor M, Nsanzimana S, Karema C, Remera E, Mutabazi V, Shyirambere C, Cyamatare P, Nutt C, Wagner C, Condo J, Misago N, Kayiteshonga Y. Validating the Children's Depression Inventory in the context of Rwanda. BMC Pediatr 2016; 16:29. [PMID: 26898199 PMCID: PMC4762156 DOI: 10.1186/s12887-016-0565-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is often co-morbid with chronic conditions, and when combined with HIV it can increase progression and reduce survival. A brief and accurate screening tool for depression among children living with HIV is necessary to increase access to mental health care and improve HIV-related outcomes in the long-term. METHODS A validation study was conducted, comparing the Children's Depression Inventory (CDI) with a structured clinical assessment as the gold standard among children living with HIV ages 7-14 years in Rwanda. The response rate was 87 % and the analysis was performed among 100 study participants. RESULTS Twenty-five percent of children had a diagnosis of depression based on the clinical interview. Sensitivity of the CDI ranged from 44 to 76 % and specificity was 92 to 100 % for cut-off scores from 5 to 9. The area under the curve (AUC) for receiver operating characteristic analysis, an estimate of overall accuracy, was 0.87 (95 % confidence interval: 0.77 - 0.97). CONCLUSIONS The significant prevalence of depression among children living with HIV in Rwanda reflects a critical need to advance mental health care in this population. Although overall accuracy of the CDI is reasonable in this context, further research needs to be done to develop a more sensitive measure of depression in this vulnerable population. Development of a highly sensitive screening measure will be a fundamental step towards improving access to mental health care among children living with HIV, potentially improving health outcomes and quality of life in the long-term as this vulnerable population transitions into adulthood.
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Affiliation(s)
- Agnes Binagwaho
- Ministry of Health of Rwanda, P.O. Box 84, Kigali, Rwanda. .,Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,University of Global Health Equity, 260 Blvd de l'Umuganda, P.O. Box 6955, Kigali, Rwanda. .,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH, 03755, USA.
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Mawuena Agbonyitor
- University of Maryland School of Medicine, 685 W Baltimore St., Baltimore, MD, 21201, USA
| | | | - Corine Karema
- Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda
| | - Eric Remera
- Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda
| | | | | | | | - Cameron Nutt
- Partners In Health, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Claire Wagner
- Dana-Farber Cancer Institute Center for Global Cancer Medicine, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Jeanine Condo
- School of Public Health, University of Rwanda, P.O. Box 5229, Kigali, Rwanda
| | - Nancy Misago
- Rwanda Biomedical Center, P.O. Box 83, Kigali, Rwanda
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Stepleman LM, Penwell-Waines L, Valvano A. Integrated care psychologists and their role in patient transition from medical to psychiatric specialty care settings: a conceptual model. Health Psychol Behav Med 2015. [DOI: 10.1080/21642850.2015.1063059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Van Sluytman L, Spikes P, Nandi V, Van Tieu H, Frye V, Patterson J, Koblin B. Ties that bind: community attachment and the experience of discrimination among Black men who have sex with men. CULTURE, HEALTH & SEXUALITY 2015; 17:859-72. [PMID: 25647586 PMCID: PMC4629835 DOI: 10.1080/13691058.2015.1004762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In the USA, the impact of psychological distress may be greater for Black men who have sex with men given that they may experience both racial discrimination in society at large and discrimination due to sexual orientation within Black communities. Attachments to community members may play a role in addressing psychological distress for members of this vulnerable population. This analysis is based on 312 Black men who have sex with men recruited for a behavioural intervention trial in New York City. Analyses were conducted using bivariate and multivariable logistic regression to examine the relationship of discrimination and community attachment to psychological distress. Most participants (63%) reported exposure to both discrimination due to race and sexual orientation. However, a majority of participants (89%) also reported racial and/or sexual orientation community attachment. Psychological distress was significant and negatively associated with older age (40 years and above), being a high school graduate and having racial and/or sexual orientation community attachments. Psychological distress was significantly and positively associated with being HIV-positive and experiencing both racial and sexual orientation discrimination. Similar results were found in the multivariable model. Susceptibility to disparate psychological distress outcomes must be understood in relation to social membership, including its particular norms, structures and ecological milieu.
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Affiliation(s)
| | - Pilgrim Spikes
- Division of HIV/AIDS Prevention, US Centers for Disease Control, Atlanta, USA
| | | | | | | | - Jocelyn Patterson
- Division of HIV/AIDS Prevention, US Centers for Disease Control, Atlanta, USA
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Stepleman LM, Decker M, Rollock M, Casillas R, Brands T. Depression screening in Black Americans with multiple sclerosis. PSYCHOL HEALTH MED 2013; 19:33-9. [DOI: 10.1080/13548506.2013.775466] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Reif SS, Pence BW, LeGrand S, Wilson ES, Swartz M, Ellington T, Whetten K. In-home mental health treatment for individuals with HIV. AIDS Patient Care STDS 2012; 26:655-61. [PMID: 23050767 PMCID: PMC3495109 DOI: 10.1089/apc.2012.0242] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Susan S Reif
- Center for Health Policy and Inequalities Research, Duke University, Charlotte, North Carolina 28207, USA.
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Mall S, Sorsdahl K, Swartz L, Joska J. "I understand just a little…" Perspectives of HIV/AIDS service providers in South Africa of providing mental health care for people living with HIV/AIDS. AIDS Care 2012; 24:319-23. [PMID: 22273005 DOI: 10.1080/09540121.2011.608790] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Research conducted in South Africa and other parts of the world has revealed that people living with HIV/AIDS (PLWHA) are more at risk of developing a mental disorder than the general population. It makes sense to explore means of integrating HIV/AIDS and mental health care thereby facilitating access of PLWHA to prompt mental health care. We conducted qualitative interviews with 22 HIV/AIDS service providers of three occupational categories (10 nurses, six adherence counsellors and six patient advocates) at three primary health care clinics in the Western Cape, South Africa. We explored the issues of knowledge and practice in mental health care as well as the role of nurses and lay health workers in providing mental health care to PLWHA thereby attempting to integrate mental health and HIV/AIDS care. Although the majority of participants were in favour of mental health screening for PLWHA, they lacked confidence to conduct the screening themselves. Most participants displayed poor knowledge of mental disorders and reported that they referred to colleagues or to an external mental health service if they suspected a possible mental disorder in a patient. Integration of mental health and HIV/AIDS care has potential benefit to the public HIV/AIDS care system. Mental health training should be provided to HIV/AIDS service providers in this regard.
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Affiliation(s)
- Sumaya Mall
- Department of Psychology, University of Stellenbosch, Cape Town, South Africa.
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