The 130th Annual Meeting of APHA

Abstract #39405

Laureen M. Kunches, RN, CS-ANP, MPH¹, Lisa R. Hirschhorn, MD, MPH², Nancy Reinhalter², Judy DeCristofaro², Joseph Musolino², and Jean Flatley McGuire, PhD³. (1) Brandeis University and JSI Research and Training Institute, 44 Farnsworth Street, Boston, MA 02210, 617-482-9485, lkunches@jsi.com, (2) JSI Research and Training Institute, 44 Farnsworth Street, Boston, MA 02210, (3) MA Dept. of Public Health HIV/AIDS Bureau, 250 Washington Street, Boston, MA 02108

Although mental health diagnoses are common among patients living with HIV (PLWH), differential impact on clinical outcomes or care patterns have not been studied. To address this question, data from random clinical chart reviews (1999-2000) in 17 MA clinics serving high numbers of un/underinsured PLWH were analyzed. The study population (N=1100) is diverse; 37% female, 22% black, 31% Hispanic and 19% born outside the US. Risk behaviors include 24% MSM and 45% IDU, with 32% having active substance abuse (SA) problems. AIDS diagnosis (55%) and hepatitis C (53%) are common. Active mental health (MH) problems were noted in 48%, and 5% had an inactive MH problem (by history). Patients with active MH problems were more likely to have an AIDS diagnosis and had significantly lower CD4 counts on entry to care. They also had higher rates of antiretroviral treatment interruption (42%), adherence problems (52%), frequent (>2/yr) missed appointments (38%), hospitalization (34%), incarceration (10%), and hepatitis C (58%). However, their virologic and CD4 outcomes during the study period were similar to patients without MH diagnoses. Mental health treatment was received by 80% of the MH patients and 69% were prescribed psychotropic medications. Depression was the most common MH diagnosis, occurring in 31% of men and 37% of women (p=0.04) and 41% of active SA patients (p<0.01). Among MH patients, SSRI's accounted for 33% of the psychotropic medications. These data suggest that psychiatric co-morbidities frequently complicate HIV disease management, but with access to multidisciplinary care, MH patients can achieve comparable clinical outcomes.

Learning Objectives:

• Identify extent of mental health co-morbidity in HIV patients receiving care in publicly-funded clinics
• Describe the care patterns and clinical outcomes in HIV patients with and without mental health diagnoses
• Recognize the additional complexity of patient management and medication adherence for the co-diagnosed population

Keywords: HIV/AIDS, Mental Disorders

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.