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Freeman MC, Wainberg ML, Slabbert JD, Mabela S, Wolvaardt G. Persons with severe mental health conditions should be included as a key population in HIV programmes. AIDS 2023; 37:2115-2118. [PMID: 37598396 PMCID: PMC10621635 DOI: 10.1097/qad.0000000000003692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Melvyn C. Freeman
- Foundation for Professional Development, Pretoria
- University of Stellenbosch, Stellenbosch, Western Cape, South Africa
| | - Milton L. Wainberg
- Columbia University/New York State Psychiatric Institute New York, New York, USA
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Arashiro P, Maciel CG, Freitas FPR, Koch GSR, da Cunha JCP, Stolf AR, Paniago AMM, de Medeiros MJ, Santos-Pinto CDB, de Oliveira EF. Adherence to antiretroviral therapy in people living with HIV with moderate or severe mental disorder. Sci Rep 2023; 13:3569. [PMID: 36864110 PMCID: PMC9980869 DOI: 10.1038/s41598-023-30451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection remains a serious public health concern, with an estimated 38 million people living with HIV (PLHIV). PLHIV are often affected by mental disorders at higher rate than the general population. One challenge in the control and prevention of new HIV infections is adherence to antiretroviral therapy (ART), with PLHIV with mental disorders having seemingly lower adherence than PLHIV without mental disorders. This cross-sectional study assessed adherence to ART in PLHIV with mental disorders who attended the Psychosocial Care Network health facilities in Campo Grande, Mato Grosso do Sul, Brazil, from January 2014 to December 2018. Data from health and medical databases were used to describe clinical-epidemiological profiles and adherence to ART. To assess the associated factors (potential risk or predisposing factors) with ART adherence, we used logistic regression model. Adherence was extremely low (16.4%). Factors associated with poor adherence were lack of clinical follow-up, particularly in middle-aged PLHIV. Other apparently associated factors were living on the streets and having suicidal ideation. Our findings reinforce the need for improvements in the care for PLHIV with mental disorders, especially in the integration between specialized mental health and infectious disease health facilities.
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Affiliation(s)
- Priscilla Arashiro
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Camila Guadeluppe Maciel
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Fernanda Paes Reis Freitas
- Hospital Universitário Maria Aparecida Pedrossiam, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | - Anderson Ravy Stolf
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Anamaria Mello Miranda Paniago
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | | | - Everton Falcão de Oliveira
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil.
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil.
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3
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Lang R, Hogan B, Zhu J, McArthur K, Lee J, Zandi P, Nestadt P, Silverberg MJ, Parcesepe AM, Cook JA, Gill MJ, Grelotti D, Closson K, Lima VD, Goulet J, Horberg MA, Gebo KA, Camoens RM, Rebeiro PF, Nijhawan AE, McGinnis K, Eron J, Althoff KN. The prevalence of mental health disorders in people with HIV and the effects on the HIV care continuum. AIDS 2023; 37:259-269. [PMID: 36541638 PMCID: PMC9782734 DOI: 10.1097/qad.0000000000003420] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe the prevalence of diagnosed depression, anxiety, bipolar disorder, and schizophrenia in people with HIV (PWH) and the differences in HIV care continuum outcomes in those with and without mental health disorders (MHDs). DESIGN Observational study of participants in the North American AIDS Cohort Collaboration on Research and Design. METHODS PWH (≥18 years) contributed data on prevalent schizophrenia, anxiety, depressive, and bipolar disorders from 2008 to 2018 based on International Classification of Diseases code mapping. Mental health (MH) multimorbidity was defined as having two or more MHD. Log binomial models with generalized estimating equations estimated adjusted prevalence ratios (aPR) and 95% confidence intervals for retention in care (≥1 visit/year) and viral suppression (HIV RNA ≤200 copies/ml) by presence vs. absence of each MHD between 2016 and 2018. RESULTS Among 122 896 PWH, 67 643 (55.1%) were diagnosed with one or more MHD: 39% with depressive disorders, 28% with anxiety disorders, 10% with bipolar disorder, and 5% with schizophrenia. The prevalence of depressive and anxiety disorders increased between 2008 and 2018, whereas bipolar disorder and schizophrenia remained stable. MH multimorbidity affected 24% of PWH. From 2016 to 2018 (N = 64 684), retention in care was marginally lower among PWH with depression or anxiety, however those with MH multimorbidity were more likely to be retained in care. PWH with bipolar disorder had marginally lower prevalence of viral suppression (aPR = 0.98 [0.98-0.99]) as did PWH with MH multimorbidity (aPR = 0.99 [0.99-1.00]) compared with PWH without MHD. CONCLUSION The prevalence of MHD among PWH was high, including MH multimorbidity. Although retention and viral suppression were similar to people without MHD, viral suppression was lower in those with bipolar disorder and MH multimorbidity.
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Affiliation(s)
- Raynell Lang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Brenna Hogan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jiafeng Zhu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Kristen McArthur
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Jennifer Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Angela M Parcesepe
- Department of Maternal and Child Health, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| | - Judith A Cook
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - M John Gill
- Department of Medicine, University of Calgary, Calgary, Canada
| | - David Grelotti
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Kalysha Closson
- School of Population and Public Health, University of British Columbia
| | - Viviane D Lima
- University of British Columbia & BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Joseph Goulet
- Yale School of Medicine & VA Connecticut Healthcare System, West Haven, Connecticut
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville
| | - Kelly A Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Peter F Rebeiro
- Departments of Medicine & Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ank E Nijhawan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathleen McGinnis
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Joseph Eron
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Closson K, Nicholson V, Lee M, McLinden T, Cassidy-Matthews C, G Card K, E Marziali M, Trigg J, Wang L, Parashar S, S G Montaner J, Gibbs A, Hart TA, Kaida A, Hogg RS. Associations between psychosocial factors and antiretroviral therapy outcomes differ by gender and sexual orientation among people living with HIV in British Columbia, Canada. AIDS Care 2023; 35:296-305. [PMID: 36169492 DOI: 10.1080/09540121.2022.2126959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Little is known about how the co-occurrence of psychosocial factors affect sub-populations of people living with HIV (PLWH). We used cross-sectional data from 999 PLWH, aged ≥19, accessing antiretroviral therapy (ART) in British Columbia, Canada (2007-2010) to examine associations between psychosocial factors and ART-related outcomes separately for trans/cis inclusive women; heterosexual men; and gay, bisexual, and other men who have sex with men (gbMSM). Multivariable logistic regression examined associations between psychosocial factors (0-3): any violence in the past 6 months, depressive symptoms in the past week, and current street drug use (heroin, crack, meth or speedball) with sub-optimal adherence (outcome 1: average annual ART adherence <95% from interview until end of follow-up, death, or December 31st, 2018) and ever viral rebound (outcome 2) adjusting for potential confounders. Of 999 PLWH (264 women, 382 heterosexual men, and 353 gbMSM), women and heterosexual men had significantly higher median counts than gbMSM. Overall, higher counts were associated with sub-optimal adherence (adjusted odds ratio [aOR] = 1.26/1-unit increase, 95%CI = 1.07-1.49). All effect estimates were of a greater magnitude among gbMSM, but not significant for women or heterosexual men, highlighting the need for population (e.g., gender and sexual orientation)-centered care and research.
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Affiliation(s)
- Kalysha Closson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Valerie Nicholson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Melanie Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | | | - Kiffer G Card
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Megan E Marziali
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jason Trigg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Surita Parashar
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Andrew Gibbs
- South African Medical Research Council, Gender and Health Unit, Durban, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal (UKZN), Durban, South Africa
| | - Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Robert S Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Hammett WH, Muanido A, Cumbe VFJ, Mukunta C, Manaca N, Hicks L, Dorsey S, Fabian KE, Wagenaar BH. Demonstration project of a lay counselor delivered trans-diagnostic mental health intervention for newly diagnosed HIV patients in Mozambique. AIDS Care 2023; 35:1-6. [PMID: 35348399 PMCID: PMC9519808 DOI: 10.1080/09540121.2022.2039356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
Abstract
ABSTRACTCommon mental disorders (CMDs) are associated with poor HIV outcomes in low- and middle-income countries. The present study implemented a psychological therapy delivered in routine HIV care and examined its effects on HIV outcomes in Mozambique. The Common Elements Treatment Approach (CETA) was integrated into routine HIV care in Sofala, Mozambique for all newly-diagnosed HIV+ patients with CMD symptoms. HIV treatment initiation and retention were compared to overall facility averages (those enrolled in CETA + those not enrolled). Of 250 patients screened, 59% (n = 148 met the criteria for CETA enrollment, and 92.6 (n = 137) enrolled in CETA. After four CETA visits, CMD symptoms decreased >50% and suicidal ideation decreased 100%. Patients enrolling in CETA had an antiretroviral therapy initiation rate of 97.1%, one-month retention of 69.2%, and three-month retention of 82.4%. Patients in the comparison group had one-month retention of 66.0% and three-month retention of 68.0%. CETA may be a promising approach to reduce symptoms of CMDs and improve HIV care cascade outcomes in areas with high HIV prevalence.
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Affiliation(s)
- Wilson H Hammett
- University of Washington, Department of Global Health, Seattle, Washington
- Health Alliance International, Seattle, WA, USA
| | | | - Vasco FJ Cumbe
- Sofala Provincial Health Directorate, Department of Mental Health, Ministry of Health, Beira, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Mozambique
| | | | - Nelia Manaca
- Health Alliance International, Beira, Mozambique
| | | | - Shannon Dorsey
- University of Washington, Department of Psychology and Behavioral Sciences, Seattle, Washington
| | - Katrin E Fabian
- University of Washington, Department of Global Health, Seattle, Washington
| | - Bradley H. Wagenaar
- University of Washington, Department of Global Health, Seattle, Washington
- Health Alliance International, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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6
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Sudler A, Cournos F, Arnold E, Koester K, Riano NS, Dilley J, Liu A, Mangurian C. The case for prescribing PrEP in community mental health settings. Lancet HIV 2021; 8:e237-e244. [PMID: 33493438 DOI: 10.1016/s2352-3018(20)30273-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 11/27/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical HIV prevention modality that is up to 99% effective in preventing HIV acquisition through sex if taken as directed. People with serious mental illness (eg, schizophrenia and bipolar disorder) are at high risk of acquiring HIV due to sexual behaviours, injection drug use, social factors, and structural discrimination that limits access to all types of preventive health services. We seek to show the importance of prioritising access to PrEP for people living with serious mental illness treated in community mental health settings. We describe barriers to prescribing PrEP, including provider attitudes and provider knowledge gaps, patient attitudes and knowledge, and systems issues. We also address the concerns that community mental health clinic administrators might have about taking on the responsibility of offering PrEP. In summary, despite the barriers to prescribing PrEP in these settings, we believe that there is a unique opportunity for community mental health settings to help address the HIV epidemic by facilitating the prescribing of PrEP to the at-risk populations they currently serve.
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Affiliation(s)
- Andrew Sudler
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Francine Cournos
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA; Northeast/Caribbean AIDS Education and Training Center, New York, NY, USA
| | - Emily Arnold
- Department of Medicine, University of California, San Francisco, CA, USA; Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Kimberly Koester
- Department of Medicine, University of California, San Francisco, CA, USA; Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Nicholas S Riano
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - James Dilley
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Alliance Health Project, University of California, San Francisco, CA, USA
| | - Albert Liu
- Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA; Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
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7
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Causal Pathways Between Severe Mental Illness and Behaviors Related to HIV: Patient Perspectives. Community Ment Health J 2020; 56:338-347. [PMID: 31535348 PMCID: PMC7756908 DOI: 10.1007/s10597-019-00466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 09/12/2019] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to identify causal pathways between HIV infection and severe mental illness. Data were collected through open-ended, semi-structured interviews. An integrated approach to the analysis, using inductive and deductive coding, was used to identify patterns among respondents. Standardized instruments were used to characterize the sample in terms of risk behaviors, physical and mental functioning and depression. Twenty-six men and women with a diagnosis of HIV and unipolar depression (n = 11) or schizophrenia/schizoaffective versus bipolar disorder (n = 15) participated. For persons with unipolar depression, the HIV diagnosis often preceded depressive symptoms. For persons with schizophrenia/schizoaffective versus bipolar disorder, mania and psychosis symptoms often preceded HIV. Substance use, incarceration and adverse childhood experiences were common across diagnoses. Attention to the directionality of effects between mental illness and HIV has important implications for anticipatory guidance for infectious disease specialists, primary care providers and public health practitioners as well as policymakers.
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8
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HIV, schizophrenia, and all-cause mortality: A population-based cohort study of individuals accessing universal medical care from 1998 to 2012 in British Columbia, Canada. Schizophr Res 2019; 209:198-205. [PMID: 31255392 DOI: 10.1016/j.schres.2019.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 02/01/2019] [Accepted: 04/26/2019] [Indexed: 11/20/2022]
Abstract
Schizophrenia is a severe mental illness with important implications for morbidity and mortality. This population-based cohort study examined the impact of schizophrenia diagnoses on all-cause mortality among a sample of people living with HIV (PLHIV) and a 10% random sample of individuals living without HIV (HIV-) in British Columbia (BC), through a data linkage between the BC Centre for Excellence in HIV/AIDS and Population Data BC's data holdings. Schizophrenia diagnoses were identified via International Classification of Diseases version 9 and version 10 codes. Age- and sex-adjusted all-cause mortality rates from January 1st, 1998 to December 31st, 2012 were calculated. Multivariable logistic models assessed (1) HIV status and mortality among individuals diagnosed with schizophrenia, (2) schizophrenia diagnosis and mortality among PLHIV, and (3) correlates of mortality among PLHIV concurrently diagnosed with schizophrenia (HIV+/SZO+). From 1998 to 2012, 6.3% of those with HIV had a schizophrenia diagnosis, compared to 1.1% of those without HIV. While significant declines in mortality rates were observed throughout the study period, mortality rates were highest among HIV+/SZO+. After adjustment for substance use disorder and age at baseline, HIV+/SZO+ had a 2.64 times greater odds of mortality (95% confidence interval [CI] = 2.14-3.25) compared to HIV-/SZO+. For PLHIV, a schizophrenia diagnosis was not associated with mortality after controlling for potential confounders (adjusted odds ratio [aOR] = 0.90, 95%CI = 0.74-1.09). Among HIV+/SZO+, age, history of injection drug use, ever having an AIDS-defining illness, and never being on anti-psychotic medication or accessing psychiatric services were associated with mortality. Efforts should be made to identify and link to care individuals disproportionately affected by schizophrenia and excess mortality, including those living with HIV.
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9
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Multilevel Factors Associated with a Lack of Viral Suppression Among Persons Living with HIV in a Federally Funded Housing Program. AIDS Behav 2019; 23:784-791. [PMID: 30680539 DOI: 10.1007/s10461-019-02399-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Persons with HIV who are receiving housing services often have high rates of engagement in care, yet many are not virally suppressed. We linked data from the New York City Housing Opportunities for Persons with AIDS (HOPWA) program to electronically reported laboratory tests from the HIV surveillance registry to examine factors associated with a lack of viral suppression. Of 1491 HOPWA consumers, 523 (35.1%) were not durably suppressed, and 253 (17.0%) were unsuppressed at their last viral load test. Substance use, age < 27 years, and emergency housing all independently predicted lack of durable viral suppression and lack of viral suppression at last viral load test.
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10
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Prevalence of HIV Viral Load Suppression Among Psychiatric Inpatients with Comorbid Substance Use Disorders. Community Ment Health J 2018; 54:1146-1153. [PMID: 29752639 PMCID: PMC6230497 DOI: 10.1007/s10597-018-0284-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 05/05/2018] [Indexed: 02/05/2023]
Abstract
A consistently suppressed viral load enables HIV (+) patients to live longer, healthier lives and reduces the probability of transmitting the virus. Since the prevalence of HIV is four times higher among those with psychiatric disorders than in the general population, it is likely that this group would also have greater difficulty remaining in care and achieving viral suppression. A secondary data analysis utilizing screening data from the Preventing AIDS Through Health (PATH) for Triples (PFT) Study were examined to assess HIV load suppression among 254 psychiatric inpatients with comorbid substance use disorders in Philadelphia. Viral load results from the past 12 months were obtained from medical records for 63 inpatients identified as HIV (+). The sample was predominately African American (76%), male (56%), and the average age was 43 years. Psychiatric disorders included depression (64%), schizophrenia (21%), and bipolar disorder (13%) with patients reporting use of alcohol (73%), cocaine (64%), cannabis (29%) and opioids (16%) prior to admission. Among this high risk sample of HIV (+) patients, about one-half (52%) achieved viral suppression, with recent opioid users six times more likely to have a detectable viral load than non-opioid users (OR 6.0; CI 1.1-31.7, p = .035). The 52% viral load suppression rate among psychiatric inpatient was higher than expected, given that the CDC's national suppression rate among those diagnosed with HIV in the general population is 58%. However, individuals with mental illness and substance use disorders require constant surveillance, monitoring, and supportive services to achieve viral suppression. Many of those who were virally suppressed were engaged in Philadelphia's extensive treatment network, whereas those who were detectable and enrolled in the PFT intervention were often homeless with unstable psychiatric symptoms and current substance use disorders, particularly opioid abuse.
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11
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Aralis HJ, Shoptaw S, Brookmeyer R, Ragsdale A, Bolan R, Gorbach PM. Psychiatric Illness, Substance Use, and Viral Suppression Among HIV-Positive Men of Color Who Have Sex with Men in Los Angeles. AIDS Behav 2018; 22:3117-3129. [PMID: 29478146 DOI: 10.1007/s10461-018-2055-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For individuals living with human immunodeficiency virus (HIV), viral suppression positively affects quality and length of life and reduces risks for HIV transmission. Men of color who have sex with men (MoCSM) who have been diagnosed with HIV have disproportionately low rates of viral suppression, with concomitant increases in incidence. We identified specific social, structural, and psychiatric factors associated with viral suppression among a sample of 155 HIV-positive MoCSM. Cigarette smoking and biological markers of recent drug use were significantly associated with detectable viral load. In contrast, individuals reporting a history of psychiatric illness during medical examination were more likely to be virally suppressed. Further analyses demonstrated that psychiatric illness may affect virologic outcomes through increased probability of being prescribed HIV medications. Alternatively, cigarette smoking and drug use appear to negatively affect subsequent HIV Care Continuum milestones such as medication adherence. Findings provide support for comprehensive intervention programs that emphasize prevention and treatment of cigarette, methamphetamine, and other drug use, and promote improved connection to psychiatric care. Continual achievement of this goal may be a crucial step to increase rates of viral suppression and slow HIV incidence in communities of MoCSM in Los Angeles and other urban areas.
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Affiliation(s)
- Hilary J Aralis
- Department of Biostatistics, University of California Los Angeles (UCLA) Fielding School of Public Health, 650 Charles E. Young Dr. South, 51-254 CHS, Los Angeles, CA, 90095-1772, USA.
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
- University of California Los Angeles (UCLA) Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Los Angeles, CA, USA
| | - Ron Brookmeyer
- Department of Biostatistics, University of California Los Angeles (UCLA) Fielding School of Public Health, 650 Charles E. Young Dr. South, 51-254 CHS, Los Angeles, CA, 90095-1772, USA
| | - Amy Ragsdale
- University of California Los Angeles (UCLA) Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Los Angeles, CA, USA
| | | | - Pamina M Gorbach
- Department of Epidemiology, University of California Los Angeles (UCLA) Fielding School of Public Health, Los Angeles, CA, USA
- Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA), Los Angeles, CA, USA
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12
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Ebuenyi I, Taylor C, O'Flynn D, Matthew Prina A, Passchier R, Mayston R. The Impact of co-morbid severe mental illness and HIV upon mental and physical health and social outcomes: a systematic review. AIDS Care 2018; 30:1586-1594. [PMID: 30114950 DOI: 10.1080/09540121.2018.1510110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Our aim was to review the evidence related to the impact of co-morbid severe mental illness SMI (schizophrenia, schizoaffective and bipolar disorder) and HIV upon mental health, physical health and social outcomes. We carried out a systematic review of scientific evidence, searching online databases (MEDLINE, PsychInfo, EMBASE, Global Health and Scopus) for studies between 1983 and 2017 using search terms for SMI and HIV. Studies were included if they compared health or social outcomes between people living with co-morbid SMI and HIV and people living with either: a) HIV only; or b) SMI only. Outcomes of interest were: mortality, health service use, HIV/SMI-related, co-morbidities, and social outcomes. We identified 20 studies which met our inclusion criteria. Although studies were generally high quality, there was heterogeneity in both selection of outcomes and choice of measure. It was therefore difficult to draw strong conclusions regarding the impact of co-morbid SMI and HIV across any outcome. We found little evidence that co-morbid SMI and HIV were associated with lower levels of treatment, care or poorer clinical outcomes compared to people living with SMI or HIV alone. However, mortality appeared to be higher among the co-morbid group in three out of four analyses identified. Physical and mental co-morbidities and social outcomes were rarely measured. Limited data mean that the impact of co-morbid SMI and HIV is uncertain. In order to develop evidence-based guidelines, there is an urgent need for further research. This may be realized by exploring opportunities for using data from existing cohort studies, routinely collected data and data linkage to investigate important questions relating to this neglected but potentially important area.
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Affiliation(s)
- Ikenna Ebuenyi
- a Athena Institute for Research on Innovation and Communication in Health and Life Sciences , Vrije Universiteit Amsterdam , Netherlands
| | - Chris Taylor
- b Department of Sexual Health and HIV , King's College Hospital London UK
| | - David O'Flynn
- c South London and Maudsley Trust , King's Health Partners
| | - A Matthew Prina
- d Centre for Global Mental Health, Health Service and Population Research , King's College London , London
| | - Ruth Passchier
- e Institute of Infectious Disease and Molecular Medicine , University of Cape Town
| | - Rosie Mayston
- d Centre for Global Mental Health, Health Service and Population Research , King's College London , London
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Rooks-Peck CR, Adegbite AH, Wichser ME, Ramshaw R, Mullins MM, Higa D, Sipe TA. Mental health and retention in HIV care: A systematic review and meta-analysis. Health Psychol 2018; 37:574-585. [PMID: 29781655 PMCID: PMC6103311 DOI: 10.1037/hea0000606] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Mental health (MH) diagnoses, which are prevalent among persons living with HIV infection, might be linked to failed retention in HIV care. This review synthesized the quantitative evidence regarding associations between MH diagnoses or symptoms and retention in HIV care, as well as determined if MH service utilization (MHSU) is associated with improved retention in HIV care. METHOD A comprehensive search of the Centers for Disease Control and Prevention's HIV/AIDS Prevention Research Synthesis database of electronic (e.g., MEDLINE, EMBASE, PsycINFO) and manual searches was conducted to identify relevant studies published during January 2002-August 2017. Effect estimates from individual studies were pooled by using random-effects meta-analysis, and a moderator analysis was conducted. RESULTS Forty-five studies, involving approximately 57,334 participants in total, met the inclusion criteria: 39 examined MH diagnoses or symptoms, and 14 examined MHSU. Overall, a significant association existed between MH diagnoses or symptoms, and lower odds of being retained in HIV care (odds ratio, OR = 0.94; 95% confidence interval [CI] [0.90, 0.99]). Health insurance status (β = 0.004; Z = 3.47; p = .001) significantly modified the association between MH diagnoses or symptoms and retention in HIV care. In addition, MHSU was associated with an increased odds of being retained in HIV care (OR = 1.84; 95% CI [1.45, 2.33]). CONCLUSIONS Results indicate that MH diagnoses or symptoms are a barrier to retention in HIV care and emphasize the importance of providing MH treatment to HIV patients in need. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - Mary M Mullins
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Darrel Higa
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Theresa Ann Sipe
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
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Yellin H, Beckwith C, Kurth A, Liu T, Castonguay B, Patrick R, Trezza C, Bazerman L, Kuo I. Syndemic effect of mental illness and substance use on viral suppression among recently-incarcerated, HIV-infected individuals in the CARE+ Corrections study. AIDS Care 2018; 30:1252-1256. [PMID: 29607658 DOI: 10.1080/09540121.2018.1455961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Few studies on HIV-related syndemics of co-occurring and mutually reinforcing psychosocial conditions have assessed clinical outcomes in criminal justice (CJ)-involved populations. Baseline data from the CARE+ Corrections study were used to quantify co-occurring mental illness and substance use and examine syndemic effects on viral suppression among 106 CJ-involved HIV-infected individuals. Ninety-one (86%) reported a mental illness diagnosis, 30 (28%) reported hazardous alcohol use, and 61 (58%) were drug dependent. Eighteen (17%) experienced all three conditions. Drug dependence was clustered with mental illness (prevalence odds ratio [POR] 3.20, 95% CI 1.01-10.14) and hazardous alcohol use (POR 2.61, 95% CI 1.03-6.56). The association between syndemic score, representing the number of conditions reported by each individual, and viral suppression was not statistically significant, although 86% of participants with none of these conditions were virally suppressed, compared to 56% of those with all three (p = 0.56). Mental illness and substance use were concentrated in this sample, indicating a need for integrated care services.
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Affiliation(s)
- Hannah Yellin
- a Department of Epidemiology and Biostatistics , George Washington University, Milken Institute School of Public Health , Washington , DC , USA
| | - Curt Beckwith
- b Division of Infectious Diseases , The Miriam Hospital , Providence , RI , USA.,c Division of Infectious Diseases , Brown University Alpert School of Medicine , Providence , RI , USA
| | - Ann Kurth
- d Yale University School of Nursing , New Haven , CT , USA
| | - Tao Liu
- e Department of Biostatistics , Brown University School of Public Health , Providence , RI , USA
| | - Breana Castonguay
- a Department of Epidemiology and Biostatistics , George Washington University, Milken Institute School of Public Health , Washington , DC , USA
| | - Rudy Patrick
- a Department of Epidemiology and Biostatistics , George Washington University, Milken Institute School of Public Health , Washington , DC , USA
| | - Claudia Trezza
- a Department of Epidemiology and Biostatistics , George Washington University, Milken Institute School of Public Health , Washington , DC , USA
| | - Lauri Bazerman
- b Division of Infectious Diseases , The Miriam Hospital , Providence , RI , USA
| | - Irene Kuo
- a Department of Epidemiology and Biostatistics , George Washington University, Milken Institute School of Public Health , Washington , DC , USA
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Abstract
OBJECTIVE Whether the rate of HIV antiretroviral therapy (ART) persistence has improved over time in the United States is unknown. We examined ART persistence trends between 2001 and 2010, using non-HIV medications as a comparator. METHODS We conducted a retrospective cohort study using Medicaid claims. We defined persistence as the duration of treatment from the first to the last fill date before a 90-day permissible gap and used Kaplan-Meier curves and Cox proportional hazard models to assess crude and adjusted nonpersistence. The secular trends of ART persistence in 43 598 HIV patients were compared with the secular trends of persistence with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARB), statins, and metformin in non-HIV-infected patients and subgroups of HIV patients who started these control medications while using ART. RESULTS Median time to ART nonpersistence increased from 23.9 months in 2001-2003 to 35.4 months in 2004-2006 and was not reached for those starting ART in 2007-2010. In adjusted models, ART initiators in 2007-2010 had 11% decreased hazard of nonpersistence compared with those who initiated in 2001-2003 (P < 0.001). For non-HIV patients initiating angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB), statins, and metformin, the hazard ratios for nonpersistence comparing 2007-2010 to 2001-2003 were 1.07, 0.94, and 1.02, respectively (all P < 0.001). For HIV patients initiating the three control medications, the hazard ratios of nonpersistence comparing 2007-2010 to 2001-2003 were 0.71, 0.65, and 0.63, respectively (all P < 0.001). CONCLUSION Persistence with ART improved between 2001 and 2010. Persistence with control medications improved at a higher rate among HIV patients using ART than HIV-negative controls.
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Risher KA, Kapoor S, Daramola AM, Paz-Bailey G, Skarbinski J, Doyle K, Shearer K, Dowdy D, Rosenberg E, Sullivan P, Shah M. Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review. AIDS Behav 2017; 21:2101-2123. [PMID: 28120257 PMCID: PMC5843766 DOI: 10.1007/s10461-017-1687-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the United States (US), there are high levels of disengagement along the HIV care continuum. We sought to characterize the heterogeneity in research studies and interventions to improve care engagement among people living with diagnosed HIV infection. We performed a systematic literature search for interventions to improve HIV linkage to care, retention in care, reengagement in care and adherence to antiretroviral therapy (ART) in the US published from 2007-mid 2015. Study designs and outcomes were allowed to vary in included studies. We grouped interventions into categories, target populations, and whether results were significantly improved. We identified 152 studies, 7 (5%) linkage studies, 33 (22%) retention studies, 4 (3%) reengagement studies, and 117 (77%) adherence studies. 'Linkage' studies utilized 11 different outcome definitions, while 'retention' studies utilized 39, with very little consistency in effect measurements. The majority (59%) of studies reported significantly improved outcomes, but this proportion and corresponding effect sizes varied substantially across study categories. This review highlights a paucity of assessments of linkage and reengagement interventions; limited generalizability of results; and substantial heterogeneity in intervention types, outcome definitions, and effect measures. In order to make strides against the HIV epidemic in the US, care continuum research must be improved and benchmarked against an integrated, comprehensive framework.
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Affiliation(s)
- Kathryn A Risher
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA.
| | - Sunaina Kapoor
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alice Moji Daramola
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Doyle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Shearer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - Eli Rosenberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Patrick Sullivan
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Determining the Cost-Savings Threshold for HIV Adherence Intervention Studies for Persons with Serious Mental Illness and HIV. Community Ment Health J 2016; 52:439-45. [PMID: 25535041 PMCID: PMC4478285 DOI: 10.1007/s10597-014-9788-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
Persons with serious mental illnesses are at increased risk for contracting and transmitting HIV and often have poor adherence to medication regimens. Determining the economic feasibility of different HIV adherence interventions among individuals with HIV and serious mental illness is important for program planners who must make resource allocation decisions. The goal of this study was to provide a methodology to estimate potential cost savings from an HIV medication adherence intervention program for a new study population, using data from prior published studies. The novelty of this approach is the way CD4 count data was used as a biological marker to estimate costs averted by greater adherence to anti-retroviral treatment. Our approach is meant to be used in other adherence intervention studies requiring cost modeling.
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Alexithymia, Assertiveness and Psychosocial Functioning in HIV: Implications for Medication Adherence and Disease Severity. AIDS Behav 2016; 20:325-38. [PMID: 26143246 DOI: 10.1007/s10461-015-1126-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Psychosocial function and adherence to antiretroviral regimen are key factors in human immunodeficiency virus (HIV) disease management. Alexithymia (AL) is a trait deficit in the ability to identify and describe feelings, emotions and bodily sensations. A structural equation model was used to test whether high levels of AL indirectly relate to greater non-adherent behavior and HIV disease severity via psychosocial dysfunction. Blood draws for HIV-1 viral load and CD4 T-lymphocyte, along with psychosocial surveys were collected from 439 HIV positive adults aged 18-73 years. The structural model supports significant paths from: (1) AL to non-active patient involvement, psychological distress, and lower social support, (2) psychological distress and non-active involvement to non-adherent behavior, and (3) non-adherence to greater HIV disease severity (CFI = .97, RMSEA = .04, SRMR = .05). A second model confirmed the intermediary effect of greater patient assertiveness on the path from AL to social support and non-active patient involvement (CFI = .94, RMSEA = .04, SRMR = .05). Altogether, AL is indirectly linked with HIV disease management through it's association with poor psychosocial function, however greater patient assertiveness buffers the negative impact of AL on relationship quality with healthcare providers and members of one's social support network.
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Therapeutic effects of minocycline on mild-to-moderate depression in HIV patients: a double-blind, placebo-controlled, randomized trial. Int Clin Psychopharmacol 2016; 31:20-6. [PMID: 26465919 DOI: 10.1097/yic.0000000000000098] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with the HIV infection are at high risk for developing depression. The aim of this study was to investigate the safety and efficacy of antidepressant effects of minocycline on HIV patients with depression. Forty-six HIV patients, with mild-to-moderate depression and a Hamilton Depression Rating Scale (HDRS) up to 18, participated in a parallel, randomized, double-blind, placebo-controlled trial and underwent 6 weeks of treatment with either minocycline (100 mg twice daily) or placebo in the same manner. Patients were assessed using HDRS at baseline and at weeks 3 and 6. The primary outcome measure was to evaluate the efficacy of minocycline in improving depressive symptoms. General linear model repeated measures showed significant effect for time × treatment interaction on the HDRS score during the trial course [F(2, 88)=7.50, P=0.001]. There was no significant difference between the two groups regarding adverse events. No serious adverse event was reported. The administration of 100 mg minocycline twice daily seems to be safe and effective in improving depressive symptoms in HIV/AIDS patients with mild-to-moderate depression.
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Karstaedt AS, Kooverjee S, Singh L, Jeenah Y, Jonsson G. Antiretroviral Therapy Outcomes in Patients with Severe Mental Illness. J Int Assoc Provid AIDS Care 2015; 14:428-33. [PMID: 26173943 DOI: 10.1177/2325957415593634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A retrospective cohort analysis was performed to describe outcomes and retention in care on antiretroviral therapy (ART) of 53 patients with severe mental illness (SMI). Diagnoses were psychosis secondary to HIV (24 patients), psychosis not otherwise specified (12), mania with or without psychosis (9), depression with psychotic features (4), and schizophrenia and bipolar mood disorder (2 each). The median baseline CD4 count was 66/mm(3) and viral load was 5.4 log10 copies/mL. Thirteen (25%) patients were lost to follow-up (10 within 6 months), 3 were transferred out, and 3 died. By week 96, 29 (85%) of 34 (64%) patients still in care had a viral load <400 copies/mL and 26 (76%) a viral load <25 copies/mL. Median CD4 count increased to 307/mm(3). Twenty-seven of 34 patients discontinued antipsychotic medication. Patients with SMI and advanced HIV infection responded well to ART. The first 6 months was important for retention in care.
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Affiliation(s)
- Alan S Karstaedt
- Department of Medicine, Division of Infectious Diseases, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Sadhna Kooverjee
- Department of Medicine, Division of Infectious Diseases, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Lucille Singh
- Department of Medicine, Division of Infectious Diseases, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Yasmien Jeenah
- Department of Psychiatry, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Gregory Jonsson
- Department of Psychiatry, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
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21
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Watkins CC, Treisman GJ. Cognitive impairment in patients with AIDS - prevalence and severity. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2015; 7:35-47. [PMID: 25678819 PMCID: PMC4319681 DOI: 10.2147/hiv.s39665] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The advent of highly active antiretroviral therapy has prolonged the life expectancy of HIV patients and decreased the number of adults who progress to AIDS and HIV-associated dementia. However, neurocognitive deficits remain a pronounced consequence of HIV/AIDS. HIV-1 infection targets the central nervous system in subcortical brain areas and leads to high rates of delirium, depression, opportunistic central nervous system infections, and dementia. Long-term HIV replication in the brain occurs in astrocytes and microglia, allowing the virus to hide from antiviral medication and later compromise neuronal function. The associated cognitive disturbance is linked to both viral activity and inflammatory and other mediators from these immune cells that lead to the damage associated with HIV-associated neurocognitive disorders, a general term given for these disturbances. We review the severity and prevalence of the neuropsychiatric complications of HIV including delirium, neurobehavioral impairments (depression), minor cognitive-motor dysfunction, and HIV-associated dementia.
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Affiliation(s)
- Crystal C Watkins
- The Memory Center in Neuropsychiatry, Sheppard Pratt Health System, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Glenn J Treisman
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Guimarães PM, Passos SR, Calvet GA, Hökerberg YH, Lessa JL, Andrade CAD. Suicide risk and alcohol and drug abuse in outpatients with HIV infection and Chagas disease. ACTA ACUST UNITED AC 2014; 36:131-7. [PMID: 24845116 DOI: 10.1590/1516-4446-2013-1219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/29/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate psychiatric comorbidities in outpatients receiving care for HIV and Chagas disease at Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil. METHODS Cross-sectional study with a consecutive sample of 125 patients referred to an outpatient psychiatric clinic from February to December 2010. The Mini International Neuropsychiatric Interview (MINI) was used. Factors associated with more frequent mental disorders were estimated by odds ratios (OR) with 95% confidence intervals (95%CI) by multiple logistic regression. RESULTS Seventy-six (60.8%) patients with HIV, 40 (32%) patients with Chagas disease, and nine (7.2%) patients with human T-lymphotropic virus were interviewed. The majority were women (64%), with up to 8 years of formal education (56%), and unemployed (81.6%). The median age was 49 years. Suicide risk (n=71) (56%), agoraphobia (n=65) (52%), major depressive episode (n=56) (44.8%), and alcohol/drug abuse (n=43) (34.4%) predominated, the latter being directly associated with lower family income (OR = 2.64; 95%CI 1.03-6.75) and HIV infection (OR = 5.24; 95%CI 1.56-17.61). Suicide risk was associated with non-white skin color (OR = 2.21; 95%CI 1.03-4.75), unemployment (OR = 2.72; 95%CI 1.01-7.34), and diagnosis of major depression (OR = 3.34; 95%CI 1.54-7.44). CONCLUSION Measures targeting adverse socioeconomic conditions and psychiatric and psychological monitoring and care should be encouraged in this population, considering the association with abuse of alcohol/other psychoactive drugs and suicide risk.
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Affiliation(s)
- Patrícia M Guimarães
- Laboratory of Clinical Epidemiology, Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Sonia R Passos
- Laboratory of Clinical Epidemiology, Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Yara H Hökerberg
- Laboratory of Clinical Epidemiology, Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - José L Lessa
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Carlos A de Andrade
- Laboratory of Clinical Epidemiology, Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
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Bhatia MS, Munjal S. Prevalence of Depression in People Living with HIV/AIDS Undergoing ART and Factors Associated with it. J Clin Diagn Res 2014; 8:WC01-4. [PMID: 25478433 DOI: 10.7860/jcdr/2014/7725.4927] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 08/19/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND HIV/AIDS is one of the most devastating illnesses that humans have ever faced. Depression in HIV/AIDS patients is very common but the factors affecting it are not well studied. AIMS AND OBJECTIVES HIV/AIDS though such a big public health problem worldwide, not enough data is available regarding association of HIV and Depression. Therefore this study was undertaken to evaluate the association between HIV/AIDS and depression in an Indian setting. MATERIAL AND METHODS The study was conducted in Guru Teg Bahadur Hospital and University College of Medical Sciences, Delhi. One hundred sixty patients were interviewed using a questionnaire containing factors that affect depression. CES-D (Center for Epidemiologic Studies - Depression) scale was used to measure depression. The data collected was analyzed using SPSS software. RESULTS The prevalence of depression in patients with HIV under ART was 58.75%. The prevalence of depression increased with the severity of symptoms. The unemployed, uneducated, unmarried, belonging to joint families, having no or low family income, migrants, having indifferent or poor relationship with spouse, poor social support and had visited commercial sex workers had a greater prevalence of depression. CONCLUSION The rate of depression in patients with HIV/AIDS is very high. Detecting depression early and treating it goes a long way in improving the compliance to treatment as well as quality of life.
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Affiliation(s)
- M S Bhatia
- Professor and Head, Department of Psychiatry, UCMS and GTB Hospital , Delhi, India
| | - Sahil Munjal
- Intern, Department of Psychiatry, UCMS and GTB Hospital , Delhi, India
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24
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Hughes AJ, Mattson CL, Scheer S, Beer L, Skarbinski J. Discontinuation of antiretroviral therapy among adults receiving HIV care in the United States. J Acquir Immune Defic Syndr 2014; 66:80-9. [PMID: 24326608 PMCID: PMC5091800 DOI: 10.1097/qai.0000000000000084] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuous antiretroviral therapy (ART) is important for maintaining viral suppression. This analysis estimates prevalence of and reason for ART discontinuation. METHODS Three-stage sampling was used to obtain a nationally representative, cross-sectional sample of HIV-infected adults receiving HIV care. Face-to-face interviews and medical record abstractions were collected from June 2009 to May 2010. Data were weighted based on known probabilities of selection and adjusted for nonresponse. Patient characteristics of ART discontinuation, defined as not currently taking ART, stratified by provider-initiated versus non-provider-initiated discontinuation, were examined. Weighted logistic regression models predicted factors associated with ART discontinuation. RESULTS Of adults receiving HIV care in the United States who reported ever initiating ART, 5.6% discontinued treatment. Half of those who discontinued treatment reported provider-initiated discontinuation. Provider-initiated ART discontinuation patients were more likely to have a nadir CD4 ≥ 200 cells per cubic millimeter. Non-provider-initiated ART discontinuation patients were more likely to have unmet need for supportive services and to have not received HIV care in the past 3 months. Among all patients who discontinued, younger age, female gender, not having continuous health insurance, incarceration, injection drug use, nadir CD4 count ≥ 2 00 cells per cubic millimeter, unmet need for supportive services, no care in the past 3 months and HIV diagnosis ≥ 5 years before interview were independently associated with ART discontinuation. CONCLUSIONS These findings inform development of interventions to increase ART persistence by identifying groups at increased risk of ART discontinuation. Evidence-based interventions targeting vulnerable populations are needed and are increasingly important as recent HIV treatment guidelines have recommended universal ART.
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Affiliation(s)
| | - Christine L. Mattson
- Division of HIV/AIDS Prevention, Center for Disease Control and Prevention, Atlanta, GA
| | - Susan Scheer
- San Francisco Department of Public Health, San Francisco, CA
| | - Linda Beer
- Division of HIV/AIDS Prevention, Center for Disease Control and Prevention, Atlanta, GA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, Center for Disease Control and Prevention, Atlanta, GA
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Carliner H, Collins PY, Cabassa LJ, McNallen A, Joestl SS, Lewis-Fernández R. Prevalence of cardiovascular risk factors among racial and ethnic minorities with schizophrenia spectrum and bipolar disorders: a critical literature review. Compr Psychiatry 2014; 55:233-47. [PMID: 24269193 PMCID: PMC4164219 DOI: 10.1016/j.comppsych.2013.09.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 09/10/2013] [Accepted: 09/18/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE People with serious mental illness (SMI) die at least 11 years earlier than the general U.S. population, on average, due largely to cardiovascular disease (CVD). Disparities in CVD morbidity and mortality also occur among some U.S. racial and ethnic minorities. The combined effect of race/ethnicity and SMI on CVD-related risk factors, however, remains unclear. To address this gap, we conducted a critical literature review of studies assessing the prevalence of CVD risk factors (overweight/obesity, diabetes mellitus, metabolic syndrome, hypercholesterolemia, hypertension, cigarette smoking, and physical inactivity) among U.S. racial/ethnic groups with schizophrenia-spectrum and bipolar disorders. METHODS AND RESULTS We searched MEDLINE and PsycINFO for articles published between 1986 and 2013. The search ultimately yielded 40 articles. There was great variation in sampling, methodology, and study populations. Results were mixed, though there was some evidence for increased risk for obesity and diabetes mellitus among African Americans, and to a lesser degree for Hispanics, compared to non-Hispanic Whites. Sex emerged as an important possible effect modifier of risk, as women had higher CVD risk among all racial/ethnic subgroups where stratified analyses were reported. CONCLUSIONS Compared to general population estimates, there was some evidence for an additive risk for CVD risk factors among racial/ethnic minorities with SMI. Future studies should include longitudinal assessment, stratification by sex, subgroup analyses to clarify the mechanisms leading to potentially elevated risk, and the evaluation of culturally appropriate interventions to eliminate the extra burden of disease in this population.
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Affiliation(s)
- Hannah Carliner
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
| | - Pamela Y Collins
- Office for Research on Disparities and Global Mental Health, National Institute of Mental Health/NIH, Bethesda, MD, USA
| | - Leopoldo J Cabassa
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, NY, USA; Columbia University School of Social Work, New York, NY, USA
| | - Ann McNallen
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sarah S Joestl
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University, New York, NY, USA; New York State Center of Excellence for Cultural Competence, New York State Psychiatric Institute, New York, NY, USA; Hispanic Treatment Program, New York State Psychiatric Institute, New York, NY, USA
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26
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Johnson EN, Roediger MP, Landrum ML, Crum-Cianflone NF, Weintrob AC, Ganesan A, Okulicz JF, Macalino GE, Agan BK. Race/ethnicity and HAART initiation in a military HIV infected cohort. AIDS Res Ther 2014; 11:10. [PMID: 24460764 PMCID: PMC3922739 DOI: 10.1186/1742-6405-11-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 01/15/2014] [Indexed: 11/24/2022] Open
Abstract
Background Prior studies have suggested that HAART initiation may vary by race/ethnicity. Utilizing the U.S. military healthcare system, which minimizes confounding from healthcare access, we analyzed whether timing of HAART initiation and the appropriate initiation of primary prophylaxis among those at high risk for pneumocystis pneumonia (PCP) varies by race/ethnicity. Methods Participants in the U.S. Military HIV Natural History Study from 1998-2009 who had not initiated HAART before 1998 and who, based on DHHS guidelines, had a definite indication for HAART (CD4 <200, AIDS event or severe symptoms; Group A), an indication to consider HAART (including CD4 <350; Group B) or electively started HAART (CD4 >350; Group C) were analyzed for factors associated with HAART initiation. In a secondary analysis, participants were also evaluated for factors associated with starting primary PCP prophylaxis within four months of a CD4 count <200 cells/mm3. Multiple logistic regression was used to compare those who started vs. delayed therapy; comparisons were expressed as odds ratios (OR). Results 1262 participants were evaluated in the analysis of HAART initiation (A = 208, B = 637, C = 479 [62 participants were evaluated in both Groups A and B]; 94% male, 46% African American, 40% Caucasian). Race/ethnicity was not associated with HAART initiation in Groups A or B. In Group C, African American race/ethnicity was associated with lower odds of initiating HAART (OR 0.49, p = 0.04). Race and ethnicity were also not associated with the initiation of primary PCP prophylaxis among the 408 participants who were at risk. Conclusions No disparities in the initiation of HAART or primary PCP prophylaxis according to race/ethnicity were seen among those with an indication for therapy. Among those electively initiating HAART at the highest CD4 cell counts, African American race/ethnicity was associated with decreased odds of starting. This suggests that free healthcare can potentially overcome some of the observed disparities in HIV care, but that unmeasured factors may contribute to differences in elective care decisions.
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Whiteley LB, Brown LK, Swenson R, Kapogiannis BG, Harper GW. Disparities in mental health care among HIV-infected youth. J Int Assoc Provid AIDS Care 2014; 13:29-34. [PMID: 23695228 PMCID: PMC3883958 DOI: 10.1177/2325957413488172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Untreated psychiatric illness is detrimental to the health and well-being of HIV-infected youth. This study examines the relationships between social and demographic variables and the rates of psychiatric treatment among HIV-infected youth. METHODS Analyses are from a cross-sectional survey of 1706 HIV-infected youth (13-26 years) in care at treatment sites or affiliates of the Adolescent Medicine Trials Network for HIV/AIDS Interventions from 2010 to 2011. Among the youth who reported recent significant mental health symptoms, comparisons on demographic variables (including race, ethnicity, language spoken, level of education, sexual orientation, and household income) were made. RESULTS Psychiatrically symptomatic black youth were significantly less likely than symptomatic nonblack peers to receive mental health care (37.4% versus 48.6%) and psychiatric medications (19.3% versus 26.9%). CONCLUSION Care providers should be alerted to the potential disparities in mental health care treatment that exist for black youth living with HIV.
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Affiliation(s)
- Laura B. Whiteley
- Bradley/Hasbro Research Center, Rhode Island Hospital and Brown University, Providence, RI
| | - Larry K. Brown
- Bradley/Hasbro Research Center, Rhode Island Hospital and Brown University, Providence, RI
| | - Rebecca Swenson
- Bradley/Hasbro Research Center, Rhode Island Hospital and Brown University, Providence, RI
| | - Bill G. Kapogiannis
- Pediatric, Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Gary W. Harper
- Department of Psychology and Master of Public Health Program, DePaul University, Chicago, IL
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Blank MB, Himelhoch S, Walkup J, Eisenberg MM. Treatment considerations for HIV-infected individuals with severe mental illness. Curr HIV/AIDS Rep 2013; 10:371-9. [PMID: 24158425 PMCID: PMC3857330 DOI: 10.1007/s11904-013-0179-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There has been a general recognition of a syndemic that includes HIV/AIDS and serve mental illnesses including schizophrenia, major depression, bipolar disorder, post-traumatic stress disorder, and others. The pathophysiology and direction of effects between severe mental illness and HIV infection is less clear however, and relatively little work has been done on prevention and treatment for people with these complex, co-occurring conditions. Here we present the most recent work that has been published on HIV and mental illness. Further, we describe the need for better treatments for "triply diagnosed persons"; those with HIV, mental illness, and substance abuse and dependence. Finally, we describe the potential drug-drug interactions between psychotropic medications and anti-retrovirals, and the need for better treatment guidelines in this area. We describe one example of an individually tailored intervention for persons with serious mental illness and HIV (PATH+) that shows that integrated community-based treatments using advanced practice nurses (APNs) as health navigators can be successful in improving health-related quality of life and reducing the burden of disease in these persons.
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Affiliation(s)
- Michael B. Blank
- Center for Mental Health Policy and Services Research, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., room 3020, Philadelphia, PA 19104-3309, (o) 215-746-6717, (f) 215-349-8715
| | - Seth Himelhoch
- Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland School of Medicine, 701 W. Pratt Street, 388, Baltimore, MD, (o) 410-706-2490, (f) 410-706-0022
| | - James Walkup
- Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson, New Brunswick, New Jersey 08504, (o) 848-932-1171, (f) 732/445-4888
| | - Marlene M. Eisenberg
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, University of Pennsylvania, 3535 Market St., Suite 4000, Philadelphia, PA 19104, (o) 215-746-5785, (f) 215-746-7377
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Avery AK, Ciomcia RW, Lincoln T, Desbrais M, Jordan AO, Rana AI, Machekano R. Jails as an opportunity to increase engagement in HIV care: findings from an observational cross-sectional study. AIDS Behav 2013; 17 Suppl 2:S137-44. [PMID: 23054036 DOI: 10.1007/s10461-012-0320-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Linkage, engagement, retention and adherence to care are necessary steps along the HIV care continuum. Progression through these steps is essential for control of the disease and interruption of transmission. Identifying and re-engaging previously diagnosed but out-of-care patients is a priority to achieve the goals of the National HIV/AIDS strategy. Participants in the EnhanceLink cohort who were previously diagnosed HIV+ (n = 1,203) were classified as not-linked to of care and non-adherent to medication prior to incarceration by self report. Results based on multivariate models indicate that recent homelessness as well as high degrees of substance abuse correlated with those classified as not-linked to care and non-adherent to medications while having insurance was associated with being linked to care and adherent to care. The majority of detainees reported being linked to care but not currently adherent to care confirming that jails are an important site for re-engaging HIV+ individuals.
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Affiliation(s)
- Ann K Avery
- MetroHealth Medical Center, 2500 MetroHealth Dr. C-2001, Cleveland, OH, 44109, USA,
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Hanna DB, Buchacz K, Gebo KA, Hessol NA, Horberg MA, Jacobson LP, Kirk GD, Kitahata MM, Korthuis PT, Moore RD, Napravnik S, Patel P, Silverberg MJ, Sterling TR, Willig JH, Lau B, Althoff KN, Crane HM, Collier AC, Samji H, Thorne JE, Gill MJ, Klein MB, Martin JN, Rodriguez B, Rourke SB, Gange SJ. Trends and disparities in antiretroviral therapy initiation and virologic suppression among newly treatment-eligible HIV-infected individuals in North America, 2001-2009. Clin Infect Dis 2013; 56:1174-82. [PMID: 23315317 PMCID: PMC3657490 DOI: 10.1093/cid/cit003] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/03/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Since the mid-1990s, effective antiretroviral therapy (ART) regimens have improved in potency, tolerability, ease of use, and class diversity. We sought to examine trends in treatment initiation and resulting human immunodeficiency virus (HIV) virologic suppression in North America between 2001 and 2009, and demographic and geographic disparities in these outcomes. METHODS We analyzed data on HIV-infected individuals newly clinically eligible for ART (ie, first reported CD4+ count<350 cells/µL or AIDS-defining illness, based on treatment guidelines during the study period) from 17 North American AIDS Cohort Collaboration on Research and Design cohorts. Outcomes included timely ART initiation (within 6 months of eligibility) and virologic suppression (≤500 copies/mL, within 1 year). We examined time trends and considered differences by geographic location, age, sex, transmission risk, race/ethnicity, CD4+ count, and viral load, and documented psychosocial barriers to ART initiation, including non-injection drug abuse, alcohol abuse, and mental illness. RESULTS Among 10,692 HIV-infected individuals, the cumulative incidence of 6-month ART initiation increased from 51% in 2001 to 72% in 2009 (Ptrend<.001). The cumulative incidence of 1-year virologic suppression increased from 55% to 81%, and among ART initiators, from 84% to 93% (both Ptrend<.001). A greater number of psychosocial barriers were associated with decreased ART initiation, but not virologic suppression once ART was initiated. We found significant heterogeneity by state or province of residence (P<.001). CONCLUSIONS In the last decade, timely ART initiation and virologic suppression have greatly improved in North America concurrent with the development of better-tolerated and more potent regimens, but significant barriers to treatment uptake remain, both at the individual level and systemwide.
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Mitchell AJ, Lord O, Malone D. Differences in the prescribing of medication for physical disorders in individuals with v. without mental illness: meta-analysis. Br J Psychiatry 2012. [PMID: 23209089 DOI: 10.1192/bjp.bp.111.094532] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND There is some concern that patients with mental illness may be in receipt of inferior medical care, including prescribed medication for medical conditions. AIMS We aimed to quantify possible differences in the prescription of medication for medical conditions in those with v. without mental illness. METHOD Systematic review and random effects meta-analysis with a minimum of three independent studies to warrant pooling by drug class. RESULTS We found 61 comparative analyses (from 23 publications) relating to the prescription of 12 classes of medication for cardiovascular health, diabetes, cancer, arthritis, osteoporosis and HIV in a total sample of 1 931 509 people. In those with severe mental illness the adjusted odds ratio (OR) for an equitable prescription was 0.74 (95% CI 0.63-0.86), with lower than expected prescriptions for angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACE/ARBs), beta-blockers and statins. People with affective disorder had an odds ratio of 0.75 (95% CI 0.55-1.02) but this was not significant. Individuals with a history of other (miscellaneous) mental illness had an odds ratio of 0.95 (95% CI 0.92-0.98) of comparable medication with lower receipt of ACE/ARBs but not highly active antiretroviral therapy (HAART) medication. Results were significant in both adjusted and unadjusted analyses. CONCLUSIONS Individuals with severe mental illness (including schizophrenia) appear to be prescribed significantly lower quantities of several common medications for medical disorders, largely for cardiovascular indications, although further work is required to clarify to what extent this is because of prescriber intent.
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Affiliation(s)
- Alex J Mitchell
- Department of Psycho-oncology, Leicestershire Partnership Trust, Leicester LE5 0TD, UK.
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Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav 2012; 16:2119-43. [PMID: 22644066 PMCID: PMC3481055 DOI: 10.1007/s10461-012-0212-3] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This is a systematic review of eighty-two published studies investigating the impact of DSM-IV mental disorders on combination antiretroviral therapy (cART) adherence and persistence among persons living with HIV/AIDS (PLWHA). Sixty-two articles examined depression, with 58 % (N = 32/62) finding lower cART adherence and persistence. Seventeen articles examined one or more anxiety disorders, with the majority finding no association with cART adherence or persistence. Eighty percent of the studies that evaluated the impact of psychotic (N = 3), bipolar (N = 5) and personality disorders (N = 2) on cART adherence and persistence also found no association. Seven out of the nine studies (78 %) evaluating the impact of antidepressant treatment (ADT) on cART adherence found improvement. Adherence and depression measurements varied significantly in studies; common research measurements would improve data harmonization. More research specifically addressing the impact of other mental disorders besides depression on cART adherence and RCTs evaluating ADT on cART adherence are also needed.
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Affiliation(s)
- Sandra A Springer
- Yale AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06511, USA.
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Moore DJ, Posada C, Parikh M, Arce M, Vaida F, Riggs PK, Gouaux B, Ellis RJ, Letendre SL, Grant I, Atkinson JH. HIV-infected individuals with co-occurring bipolar disorder evidence poor antiretroviral and psychiatric medication adherence. AIDS Behav 2012; 16:2257-66. [PMID: 22041931 DOI: 10.1007/s10461-011-0072-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The contribution of bipolar disorder (BD), a prevalent serious mental illness characterized by impulsivity and mood instability, to antiretroviral (ART) and psychiatric medication adherence among HIV-infected (HIV+) individuals is unknown. We examined medication adherence among 44 HIV+/BD+ persons as compared to 33 demographically- and medically-comparable HIV+/BD- persons. Classification of adherent (≥ 90%) or non-adherent (<90%) based on proportion of correctly taken doses over 30 days was determined using electronic medication monitoring devices. HIV+/BD+ persons were significantly less likely to be ART adherent (47.7%) as compared to HIV+/BD- (90.9%) persons. Within the HIV+/BD+ group, mean psychiatric medication adherence was significantly worse than ART medication adherence, although there was a significant correlation between ART and psychiatric adherence levels. Importantly, 30-day ART adherence was associated with plasma virologic response among HIV+/BD+ individuals. Given the high overlap of HIV and BD, and the observed medication adherence difficulties for these persons, specialized adherence improvement interventions are needed.
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Affiliation(s)
- David J Moore
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, USA.
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Chen MH, Su TP, Chen TJ, Cheng JY, Wei HT, Bai YM. Identification of psychiatric disorders among human immunodeficiency virus-infected individuals in Taiwan, a nine-year nationwide population-based study. AIDS Care 2012; 24:1543-9. [DOI: 10.1080/09540121.2012.672716] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Mu-Hong Chen
- a Department of Psychiatry , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Tung-Ping Su
- a Department of Psychiatry , Taipei Veterans General Hospital , Taipei , Taiwan
- c Department of Psychiatry , National Yang-Ming University , Taipei , Taiwan
| | - Tzeng-Ji Chen
- b Department of Family Medicine , Taipei Veterans General Hospital , Taipei , Taiwan
- d Institute of Hospital and Health Care Administration , National Yang-Ming University , Taipei , Taiwan
| | - Ju-Yin Cheng
- a Department of Psychiatry , Taipei Veterans General Hospital , Taipei , Taiwan
- c Department of Psychiatry , National Yang-Ming University , Taipei , Taiwan
| | - Han-Ting Wei
- a Department of Psychiatry , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Ya-Mei Bai
- a Department of Psychiatry , Taipei Veterans General Hospital , Taipei , Taiwan
- c Department of Psychiatry , National Yang-Ming University , Taipei , Taiwan
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Kreyenbuhl J, Leith J, Medoff DR, Fang L, Dickerson FB, Brown CH, Goldberg RW, Potts W, Dixon LB. A comparison of adherence to hypoglycemic medications between Type 2 diabetes patients with and without serious mental illness. Psychiatry Res 2011; 188:109-14. [PMID: 21459458 PMCID: PMC3673565 DOI: 10.1016/j.psychres.2011.03.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 01/24/2011] [Accepted: 03/10/2011] [Indexed: 11/15/2022]
Abstract
Inadequate self-management of chronic medical conditions like Type 2 diabetes may play a role in the poor health status of individuals with serious mental illnesses. We compared adherence to hypoglycemic medications and blood glucose control between 44 diabetes patients with a serious mental illness and 30 patients without a psychiatric illness. The two groups did not differ in their ability to manage a complex medication regimen as assessed by a performance-based measure of medication management capacity. However, significantly fewer patients with a mental illness self-reported nonadherence to their hypoglycemic regimens compared to those without a mental illness. Although individuals with mental illnesses also had better control of blood glucose, this metabolic parameter was not correlated with adherence to hypoglycemic medications in either patient group. The experience of managing a chronic mental illness may confer advantages to individuals with serious mental illnesses in the self-care of co-occurring medical conditions like Type 2 diabetes.
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Affiliation(s)
- Julie Kreyenbuhl
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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De Hert M, Trappeniers L, Wampers M, Van Damme P, Van Hal G, Peuskens J. Knowledge about HIV in people with schizophrenia: a general population comparison. ACTA ACUST UNITED AC 2011; 5:80-6. [PMID: 21693431 DOI: 10.3371/csrp.5.2.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with schizophrenia are at higher risk for human immunodeficiency virus infection (HIV) positivity compared to the general population. Only a limited number of studies have evaluated the knowledge about HIV in people with schizophrenia. OBJECTIVES To compare the knowledge about HIV between people with schizophrenia and the general population. METHODS The knowledge about HIV was assessed with a questionnaire used in the general health survey of the Belgian population in 2004. RESULTS Patients with schizophrenia had a significantly better knowledge about nontransmissible contacts compared to the general population (43.2% vs. 32.6%, df=1, chi-square=11.0; p=0.0009). There was no difference regarding the knowledge about protective methods (50.7% vs. 55.9%, df=1, chi-square=2.45; p=0.12). Patients had a better appreciation about the severity and treatment options for acquired immunodeficiency syndrome (AIDS) (54.6% vs. 37.9%, df=1, chi-square=25.91; p<0.0001). CONCLUSIONS Although the overall knowledge about HIV in patients with schizophrenia is better than that of the general population, it is far from optimal. There is a need for systematic educational programs to improve knowledge.
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Affiliation(s)
- Marc De Hert
- University Psychiatric Center Katholieke Universiteit Leuven, Campus Kortenberg, Belgium.
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Psychiatric correlates of HAART utilization and viral load among HIV-positive impoverished persons. AIDS 2011; 25:1113-8. [PMID: 21399478 DOI: 10.1097/qad.0b013e3283463f09] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Research on the role psychiatric factors in HIV disease management has yielded discrepant findings, possibly because prior studies did not include comprehensive psychiatric screeners. This study administered a validated screener to examine psychiatric correlates of highly active antiretroviral therapy (HAART) utilization and viral load. DESIGN Community-recruited, HIV-positive impoverished persons provided sociodemographic information, completed a Diagnostic Interview Schedule that screened for psychiatric disorders, and provided a blood sample to measure HIV disease markers. METHODS In this cross-sectional investigation with 227 participants, a multiple logistic regression model examined correlates of HAART utilization compared to a reference group that was eligible for (i.e. CD4(+) cell count <350 cells/μl) but not taking HAART. A multiple linear regression model examined correlates of HIV viral load among 147 participants on HAART. RESULTS Sleeping on the street [adjusted OR (AOR) = 0.06; 95% confidence interval (CI) = 0.01–0.26] and screening positive for a stimulant use disorder (AOR = 0.29; 95% CI = 0.13–0.65) were independently associated with lower odds of HAART utilization. Conversely, enrollment in the AIDS Drug Assistance Program (AOR = 3.94; 95% CI = 1.45–10.73) and receipt of mental health treatment (AOR = 4.78; 95% CI = 1.77–12.87) were independently associated with increased odds of HAART utilization. Among those on HAART, screening positive for a severe mental illness was independently associated with a six-fold higher viral load. CONCLUSION Providing psychiatric treatment could optimize health outcomes among HIV-positive impoverished persons and boost the effectiveness of 'test and treat' approaches to HIV prevention.
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DeLorenze GN, Satre DD, Quesenberry CP, Tsai AL, Weisner CM. Mortality after diagnosis of psychiatric disorders and co-occurring substance use disorders among HIV-infected patients. AIDS Patient Care STDS 2010; 24:705-12. [PMID: 20969465 DOI: 10.1089/apc.2010.0139] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We examined the associations between psychiatric diagnoses, substance use disorders, health services, and mortality among 9751 HIV-infected patients (≥14 years old) in a large, private medical care program, in a retrospective cohort design over a 12-year period. All study data were extracted from computerized clinical and administrative databases. Results showed that 25.4% (n = 2472) of the 9751 study subjects had received a psychiatric diagnosis (81.1% had major depression, 17.1% had panic disorder, 14.2% had bipolar disorder, and 8.1% had anorexia/bulimia); and 25.5% (n = 2489) had been diagnosed with substance use disorder; 1180 (12.1%) patients had received both psychiatric and substance diagnoses. In comparison to patients with neither a psychiatric diagnosis nor a SU diagnosis, the highest risk of death was found among patients with dual psychiatric and substance use diagnoses who had no psychiatric treatment visits and no substance treatment (relative hazards [RH] = 4.17, 95% confidence interval [CI] = 2.35 to 7.40). Among dually diagnosed patients, receiving psychiatric and/or substance use disorder treatment somewhat reduced the risk of death compared to patients with neither diagnosis. The lowest risks of death were observed among patients with a single diagnosis who had received corresponding treatment. Our study findings suggest that screening for psychiatric and substance problems at the initiation and during the course of HIV/AIDS treatment and providing psychiatric and substance use disorder treatment may extend life for these vulnerable patients.
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Affiliation(s)
- Gerald N. DeLorenze
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Psychiatry, University of California, San Francisco, California
| | | | - Ai-Lin Tsai
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Constance M. Weisner
- Division of Research, Kaiser Permanente Northern California, Oakland, California
- Department of Psychiatry, University of California, San Francisco, California
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Palmer NB, Basinski JR, Uldall KK. Psychiatric illness, access and adherence to HAART: a brief review of recent findings and implications for care. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/hiv.10.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This review outlines research since 2006 addressing psychiatric illness and/or co-occurring psychiatric illness and substance abuse as it relates to HAART access and adherence. Highlighted here are effective or promising interventions, or models of care, designed to enhance adherence among HIV-infected individuals with mental illness. Overall, we found that recent studies reinforce earlier findings that co-occurring substance abuse and psychiatric illness are associated with HAART nonadherence. Studies of depression/anxiety disorders among HIV patients reviewed here show that while depression is related to poorer medication adherence, treatment for depression can lead to increased HAART adherence. New studies also suggest that HIV patients with psychiatric diagnoses can effectively maintain HAART adherence with close monitoring by providers. While there are still very few adherence interventions among HIV patients with co-occurring mental illness and substance abuse, promising interventions include cognitive behavioral therapy and integration of mental health services with HIV primary care.
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Affiliation(s)
- Nancy B Palmer
- Seattle Children’s Research Institute, Seattle Children’s Research Institute, WA, USA
| | - James R Basinski
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359896, Seattle, WA 98104-2499 USA
| | - Karina K Uldall
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359896, Seattle, WA 98104-2499 USA
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