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Dahiya P, Riano NS, Dilley JW, Olfson M, Cournos F, Mangurian C, Arnold EA. Care challenges and silver linings in HIV and behavioral health service delivery for individuals living with HIV and severe mental illness during the COVID-19 pandemic: a qualitative study. BMC Health Serv Res 2024; 24:690. [PMID: 38822307 PMCID: PMC11143645 DOI: 10.1186/s12913-024-11146-1] [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: 07/31/2023] [Accepted: 05/24/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND There has been a longstanding effort to integrate behavioral health and HIV care for people with comorbid HIV and behavioral health needs, including those with severe mental illness (SMI). As this population frequents both behavioral health and HIV care settings, they were likely to experience new obstacles to the quality and availability of care during the COVID-19 pandemic. This study aims to describe how clinics for HIV services or behavioral healthcare-as well as co-located sites providing both-sought to rapidly shift protocols to maintain a standard of patient care for people with comorbid HIV and SMI while adapting to the unprecedented circumstances of the pandemic. METHODS We interviewed HIV and behavioral healthcare providers, clinic leaders, and support service agencies that served clients impacted by both HIV and SMI. Seventeen key informants across three settings (HIV care settings, behavioral health care settings, and integrated or co-located care settings) were interviewed in 2022. Interviews focused on changes in clinical services, protocols, and care provision strategies during and at the onset of the COVID-19 pandemic. Interviews were transcribed and coded using thematic analysis. RESULTS Commonly endorsed themes included both positive and negative changes in care and care provision during the pandemic. Negative impacts of the pandemic included the loss of physical space, exacerbated mental health needs and disengagement in HIV care, patient barriers to telehealth and the digital divide, and increased healthcare workforce burnout. Positive changes included improved healthcare delivery and care engagement through telehealth, new opportunities to provide a wide range of social services, paradoxical increases in engagement in HIV care for certain patients, and broad institution of workforce wellness practices. CONCLUSIONS Though COVID-19 presented several complex barriers to care for providers serving patients with comorbid HIV and SMI, the increased flexibility afforded by telehealth and a greater focus on collaborative approaches to patient care may benefit this patient population in the future. Additionally, the focus on workforce wellness may serve to increase retention and avoid burnout among providers. The strategies and lessons learned through adapting to COVID-19 may be invaluable moving forward as healthcare systems respond to future pandemics.
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Affiliation(s)
- Priya Dahiya
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
| | - Nicholas S Riano
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
- Department of Psychological Science, School of Social Ecology, University of California Irvine. 4220 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, USA
| | - James W Dilley
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
| | - Mark Olfson
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA
| | - Francine Cournos
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA
| | - Christina Mangurian
- Department of Psychiatry & Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, School of Medicine, 675 18th St, San Francisco, CA, 94143, USA
- Department of Epidemiology & Biostatistics, University of California San Francisco, School of Medicine, 550 16th Street, Second Floor, San Francisco, CA, 94158, USA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, 2789 25th Street, Suite 350, San Francisco, CA, 94110, USA
| | - Emily A Arnold
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, Box 0886, San Francisco, CA, 94143, USA.
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O'Grady T, Inman N, Younger A, Huang B, Bouton TO, Kim H, DeLorenzo E. The Characteristics and HIV-Related Outcomes of People Living with Co-occurring HIV and Mental Health Conditions in the United States: A Systematic Review of Literature from 2016 to 2021. AIDS Behav 2024; 28:201-224. [PMID: 37563293 PMCID: PMC10803443 DOI: 10.1007/s10461-023-04150-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
Considering advances in HIV prevention and treatment, jurisdictional efforts to end the HIV/AIDS epidemic, and reduced stigma towards people living with HIV infection and mental health conditions, the authors systematically reviewed studies published between 2016 and 2021 and identified 45 studies that met the eligibility criteria. The review found that stigma towards mental health conditions still acts as a barrier to accessing HIV treatment, which impacts treatment outcomes. Additionally, social determinants of health, such as housing instability and poverty, appear to impact mental health and, therefore, HIV-related outcomes. The review also highlighted the mutually reinforcing effects of HIV, mental health, and substance use conditions, providing valuable insights into the syndemic effects of these co-occurring conditions. Overall, the review highlights the need to address stigma and social determinants of health in HIV prevention and treatment efforts and to integrate mental health services into HIV care to improve outcomes for people living with both HIV and mental health conditions.
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Affiliation(s)
- Thomas O'Grady
- New York State Department of Health, AIDS Institute, Albany, NY, USA.
- New York State Department of Health, Corning Tower, ESP, Room 760, Albany, NY, 12237-0627, USA.
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, 1 University Pl, Rensselaer, NY, 12144, USA.
| | - Nina Inman
- New York State Department of Health, AIDS Institute, Albany, NY, USA
| | - Alitasha Younger
- New York State Department of Health, AIDS Institute, Albany, NY, USA
| | - Bishan Huang
- New York State Department of Health, AIDS Institute, Albany, NY, USA
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, 1 University Pl, Rensselaer, NY, 12144, USA
| | | | - Heeun Kim
- New York State Department of Health, AIDS Institute, Albany, NY, USA
| | - Emily DeLorenzo
- New York State Department of Health, AIDS Institute, Albany, NY, USA
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MANGURIAN C, DAHIYA P, GOLDMAN ML, CORBEIL T, WALL MM, ESSOCK SM, DIXON LB, TANG F, FRIMPONG E, MASCAYANO F, RADIGAN M, WANG R, OLFSON M, SMITH TE. Underdetection of pre-existing HIV/AIDS during psychiatric hospitalizations. AIDS 2022; 36:1031-1037. [PMID: 35142705 PMCID: PMC9167207 DOI: 10.1097/qad.0000000000003190] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES People with severe mental illness are 10 times more likely to have HIV/ AIDS than the general population, yet little is known about the characteristics and frequency of recognition of pre-existing HIV/AIDS diagnoses among inpatients with severe mental illness. This study examines documentation rates of pre-existing HIV/ AIDS among inpatients within psychiatric hospitals in New York State. DESIGN Retrospective cohort study to examine recognition of pre-existing HIV/AIDS among psychiatric inpatients. METHODS Patient-level Medicaid claims records were linked with hospital and regional data for people admitted to psychiatric inpatient units in New York State. Presence of HIV/AIDS diagnoses prior to psychiatric hospitalization was coded for each inpatient (n = 14 602). Adjusted odds ratios of undocumented HIV/AIDS diagnoses at the time of discharge were calculated using logistic regression analyses. RESULTS About 5.1% (741/14 602) of unique psychiatric inpatients had pre-existing HIV/AIDS diagnoses. Of these inpatients, 58.3% (432/741) were not coded as having HIV/AIDS upon discharge. Higher rates of missed detection were associated with younger age, non-Hispanic white race/ethnicity, shorter length of stay, more distal coding of an HIV/AIDS diagnosis, and fewer HIV/AIDS-related Medicaid claims in the past year. Hospitals with higher readmission rates also had higher rates of undetected HIV/AIDS diagnoses. CONCLUSION Over half of inpatients previously diagnosed with HIV/AIDS did not have their HIV-positive status noted upon discharge from psychiatric hospitalization. This finding underscores how frequently clinically significant medical comorbidities fail to be incorporated into psychiatric treatment and treatment planning. Inpatient clinicians are missing important opportunities to optimize HIV/AIDS treatment and reduce morbidity and mortality.
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Affiliation(s)
- Christina MANGURIAN
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
- Department of Epidemiology & Biostatistics, University of California San Francisco
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital
| | - Priya DAHIYA
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | - Matthew L. GOLDMAN
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco
| | | | - Melanie M. WALL
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Susan M. ESSOCK
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Lisa B. DIXON
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Fei TANG
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Eric FRIMPONG
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | | | - Marleen RADIGAN
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Rui WANG
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Mark OLFSON
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Thomas E. SMITH
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
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