Abstract
The Patient-centered HIV Care Model (PCHCM) integrated community-based pharmacists with medical providers and required sharing of patient clinical information and collaborative therapy-related action planning. We determined the proportions of participants with HIV and mental health conditions who were retained in care and the proportion virally suppressed, pre- and post-implementation. Overall, we found a relative 13% improvement in both retention [60% to 68% (p = 0.009)] and viral suppression [79% to 90% (p < 0.001)]. Notable improvements were seen among persons triply diagnosed with HIV, mental illness and substance use [+ 36% (50% to 68%, p = 0.036) and + 32% (66% to 86%, p = 0.001) in retention and viral suppression, respectively]. There were no differences in the proportions of persons adherent to psychiatric medications, pre- to post-implementation, nor were there differences in the proportions of persons retained in care or virally suppressed by psychiatric medication adherence, post-implementation. PCHCM demonstrated that collaborations between community-based pharmacists and medical providers can improve HIV care continuum outcomes among persons with mental health conditions.
Resumen
El modelo de atención para el VIH centrada en el paciente (PCHCM) integró a farmacéuticos de la comunidad y a proveedores médicos, y requirió compartir la información clínica del paciente y planificar medidas colaborativas relacionadas con la terapia. Determinamos las proporciones de participantes con VIH y afecciones de salud mental que permanecieron bajo atención médica y la proporción de quienes habían logrado la supresión viral, antes y después de la implementación. En líneas generales, hallamos una mejoría relativa del 13% tanto en la permanencia bajo atención médica (60% a 68% [p = 0.009]) como en la supresión viral (79% a 90% [p < 0.001]). Se observaron mejorías notables entre personas con diagnóstico triple de VIH, enfermedad mental y consumo de sustancias (+ 36% [50% a 68%, p=0.036] y +32 % [66% a 86%, p = 0.001] en la permanencia bajo atención médica y la supresión viral, respectivamente). No hubo diferencias en las proporciones de personas con adhesión a los medicamentos siquiátricos, desde antes hasta después de la implementación, ni tampoco diferencias en la proporción de personas que permanecieron bajo atención médica o con supresión viral por su adhesión a los medicamentos siquiátricos, después de la implementación. El PCHCM demostró que las colaboraciones entre los farmacéuticos de la comunidad y los proveedores médicos pueden mejorar los resultados del proceso continuo de atención para el VIH entre personas con afecciones de salud mental.
Similar content being viewed by others
References
Tegger MK, Crane HM, Tapia KA, et al. The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals. AIDS Patient Care STDS. 2008;22(3):233–43.
Kessler RC, Demler O, Frank RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med. 2005;352(24):2515–23.
Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.
Nanni MG, Caruso R, Mitchell AJ, et al. Depression in HIV infected patients: a review. Curr Psychiatry Rep. 2015;17(1):530.
Rooks-Peck CR, Adegbite AH, Wichser ME, et al. Mental health and retention in HIV care: a systematic review and meta-analysis. Health Psychol. 2018;37(6):574–85.
Gonzalez JS, Batchelder AW, Psaros C, et al. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58(2):181–7.
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(8):2119–43.
Pence BW, Miller WC, Gaynes BN, et al. Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2007;44(2):159–66.
Yehia BR, Stephens-Shield AJ, Momplaisir F, et al. Health outcomes of HIV-infected people with mental illness. AIDS Behav. 2015;19(8):1491–500.
Pence BW, Mills JC, Bengtson AM, et al. Association of increased chronicity of depression with HIV appointment attendance, treatment failure, and mortality among HIV-infected adults in the United States. JAMA Psychiatry. 2018;75(4):379–85.
Remien RH, Stirratt MJ, Nguyen N, et al. Mental health and HIV/AIDS: the need for an integrated response. AIDS. 2019;33(9):1411–20.
Helleberg M, Pedersen MG, Pedersen CB, et al. Associations between HIV and schizophrenia and their effect on HIV treatment outcomes: a nationwide population-based cohort study in Denmark. Lancet HIV. 2015;2(8):e344–50.
Hartzler B, Dombrowski JC, Crane HM, et al. Prevalence and predictors of substance use disorders among HIV care enrollees in the United States. AIDS Behav. 2017;21(4):1138–48.
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The NSDUH report: HIV/AIDS and substance use. Rockville: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality; 2010.
Nolan S, Walley AY, Heeren TC, et al. HIV-infected individuals who use alcohol and other drugs, and virologic suppression. AIDS Care. 2017;29(9):1129–36.
Hartzler B, Dombrowski JC, Williams JR, et al. Influence of substance use disorders on 2-year HIV care retention in the United States. AIDS Behav. 2018;22(3):742–51.
Biello KB, Oldenburg CE, Safren SA, et al. Multiple syndemic psychosocial factors are associated with reduced engagement in HIV care among a multinational, online sample of HIV-infected MSM in Latin America. AIDS Care. 2016;28(Suppl 1):84–91.
Blashill AJ, Bedoya CA, Mayer KH, et al. Psychosocial syndemics are additively associated with worse ART adherence in HIV-infected individuals. AIDS Behav. 2015;19(6):981–6.
Friedman MR, Stall R, Silvestre AJ, et al. Effects of syndemics on HIV viral load and medication adherence in the Multicentre AIDS Cohort Study. AIDS. 2015;29(9):1087–96.
Glynn TR, Safren SA, Carrico AW, et al. High levels of syndemics and their association with adherence, viral non-suppression, and biobehavioral transmission risk in Miami, a U.S. City with an HIV/AIDS epidemic. AIDS Behav. 2019;23(11):2956–65.
Harkness A, Bainter SA, O’Cleirigh C, et al. Longitudinal effects of syndemics on ART non-adherence among sexual minority men. AIDS Behav. 2018;22(8):2564–74.
Mizuno Y, Purcell DW, Knowlton AR, et al. Syndemic vulnerability, sexual and injection risk behaviors, and HIV continuum of care outcomes in HIV-positive injection drug users. AIDS Behav. 2015;19(4):684–93.
Byrd KK, Hardnett F, Clay PG, et al. Retention in HIV care among participants in the Patient-centered HIV Care Model: a collaboration between community-based pharmacists and primary medical providers. AIDS Patient Care STDS. 2019;33(2):58–66.
Byrd KK, Hou JG, Bush T, et al. Adherence and viral suppression among participants of the Patient-centered HIV Care Model project—a collaboration between community-based pharmacists and HIV clinical providers. Clin Infect Dis. 2020;70(5):789–97.
American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication therapy management in pharmacy practice: core elements of an MTM service model (version 2.0). J Am Pharm Assoc (2003). 2008;48:341–53.
Department of Health and Human Services. HIV/AIDS Bureau performance measures. https://hab.hrsa.gov/sites/default/files/hab/clinical-quality-management/coremeasures.pdf. Accessed 5 June 2018.
Nau, D. Proportion of Days Covered (PDC) as a preferred method of measuring medication adherence. https://www.pqaalliance.org/images/uploads/files/pqa%20pdc%20vs%20%20mpr.pdf. Accessed 5 June 2018.
PQAalliance. PQA measure overview. https://www.PQAalliance.org/assets/measures/2019_pqa_measure_overview.pdf. Accessed 14 Sep 2019.
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. Department of Health and Human Services. https://www.aidsinfo.nih.gov/contentfiles/adultandadolescentgl.pdf. Accessed 5 June 2018.
Günthard HF, Saag MS, Benson CA, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2016 recommendations of the International Antiviral Society-USA Panel. JAMA. 2016;316(2):191–21010.
Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 dependent areas, 2016. HIV surveillance supplemental report 2018; 23 (no. 4). https://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published June 2018. Accessed 10 Sep 2019.
White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States: updated to 2020. https://files.hiv.gov/s3fs-public/nhas-update.pdf. Accessed 14 Sept 2019.
Joint United Nations Programme on HIV/AIDS (UNAIDS). 90-90-90 An ambitious treatment target to help end the AIDS epidemic. https://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf. Accessed 8 April 2020.
Durvasula R, Miller TR. Substance abuse treatment in persons with HIV/AIDS: challenges in managing triple diagnosis. Behav Med. 2014;40(2):43–52.
Chander G, Himelhoch S, Fleishman JA, et al. HAART receipt and viral suppression among HIV-infected patients with co-occurring mental illness and illicit drug use. AIDS Care. 2009;21(5):655–63.
Yellin H, Beckwith C, Kurth A, et al. 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(10):1252–6.
Cranston K, Alpren C, John B, et al. Notes from the field: HIV diagnoses among persons who inject drugs—northeastern Massachusetts, 2015–2018. Morb Mortal Wkly Rep. 2019;68(10):253–4.
Golden MR, Lechtenberg R, Glick SN, et al. Outbreak of human immunodeficiency virus infection among heterosexual persons who are living homeless and inject drugs—Seattle, Washington, 2018. Morb Mortal Wkly Rep. 2019;68(15):344–9.
Peters PJ, Pontones P, Hoover KW, et al. HIV infection linked to injection use of oxymorphone in Indiana, 2014–2015. N Engl J Med. 2016;375(3):229–39.
Mugavero MJ, Lin HY, Willig JH, et al. Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis. 2009;48(2):248–56.
Hall HI, Gray KM, Tang T, et al. Retention in care of adults and adolescents living with HIV in 13 U.S. areas. J Acquir Immune Defic Syndr. 2012;60(1):77–82.
Acknowledgements
This work was supported by the Secretary’s Minority AIDS Initiative Fund and the Centers for Disease Control and Prevention through a Co-operative Agreement (Grant Number NU65PS004275) with the University of North Texas Health Science Center System College of Pharmacy. Walgreens Co. provided all pharmacist services in-kind. Patient-centered HIV Care Model Team Michael Aguirre, Osayi Akinbosoye, David M. Bamberger, Ben Bluml, Katura Bullock, Diane C. Burrell, Tim Bush, Clifton Bush, Kathy K. Byrd (Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS US8-4, Atlanta, GA, 30329, USA), Chad Cadwell, Nasima M. Camp (Department of Health, Research, Informatics, and Technology, ICF, Atlanta, GA, USA), Roberto Cardarelli, Terri Clark, Patrick G. Clay (Department of Pharmacotherapy, University of North Texas Health Science Center System College of Pharmacy, Fort Worth, TX, USA), Andrew Crim, Angela Cure, Kristin Darin, Traci Dean, Ambrose Delpino, Michael DeMayo, Shara Elrod, Ashley L. Eschmann, David Farmer, Rose Farnan, Heather Free, Andrew Gudzelak Jr., Andrew Halbur, Felicia Hardnett (Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS US8-4, Atlanta, GA, 30329, USA), Ronald Hazen, Heidi Hilker, John Hou (Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, IL, USA), Brian Hujdich, Lisa Johnson, Heather Kirkham, James Lecounte, Sayuri Lio, Guanzhong Lo, Mazzoni Center HIV Care Team of Clinicians, Sondra Middleton, Brittany Mills, Stacy Muckelroy, Christopher M. Nguyen, Linda Ortiz, Glen Pietrandoni, Kimberly K. Scarsi, Jon Schommer, Michael D. Shankle (HealthHIV, Washington, DC, USA), Ram Shrestha, Daron Smith, Sumihiro Suzuki (Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA), Michael S. Taitel (Health Analytics, Research, and Reporting Department, Walgreen Co., Deerfield, IL, USA), Gebeyehu N. Teferi, Vikas Tomer, Louis Torres, Paul J. Weidle (Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS US8-4, Atlanta, GA, 30329, USA), Carmelita Whitfield, and Jason E. Willman.
Author information
Authors and Affiliations
Consortia
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The findings and conclusions of this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
The members of Patient-Centered HIV Care Model Team were given in Acknowledgements.
Rights and permissions
About this article
Cite this article
Byrd, K.K., Hardnett, F., Hou, J.G. et al. Improvements in Retention in Care and HIV Viral Suppression Among Persons with HIV and Comorbid Mental Health Conditions: Patient-Centered HIV Care Model. AIDS Behav 24, 3522–3532 (2020). https://doi.org/10.1007/s10461-020-02913-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-020-02913-2