 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Seth Himelhoch, MD, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Carnegie 285, Baltimore, MD 21287, (410)614-4525, shimelh1@jhmi.edu, Kelly Gebo, MD, MPH, Department of Medicine, Johns Hopkins University, Room 442, 1830 E. Monument St., Baltimore, MD 21287, William Breakey, MD, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD 21287, and Neil R. Powe, MD MPH MBA, Department of Epidemiology, Johns Hopkins University, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21205.
Background: Individuals with schizophrenia are at high risk of developing HIV and are known to experience barriers to medical care. This study sought to determine, among a cohort of HIV clinicians, whether or not the co-morbid diagnosis of schizophrenia affected the decision to offer highly active antiretroviral therapy (HAART) to AIDS patients. Methods: We conducted a cross-sectional study of a national sample of 700 HIV experts drawn from the American Academy of HIV Medicine. Participants were mailed a questionnaire consisting of a case vignette of an AIDS patient followed by questions regarding factors associated with their decision to recommend HAART. Participants were randomly assigned to receive a case vignette with or without a diagnosis of schizophrenia. Results: 94% of clinicians were located, with a response rate of 53% (347/659). There were no significant demographic or work related differences between responders and non-responders. There was no difference in recommendation of antiretroviral treatment or prescribing HAART between those who received a case vignette with schizophrenia vs. those who did not (p>0.05). Compared to those receiving a vignette without schizophrenia, those that received vignettes with schizophrenia were more likely avoid prescribing efavirenz (p<0.001), and more likely to agree to be helped by a specialist (p<0.001). They were also more likely to recommend directly observed therapy (p<0.001). Results are unchanged even after adjusting for clinician demographic and work related factors.Conclusions: HIV clinicians recognize the need to incorporate mental health specialists in treating patients with schizophrenia and avoid medications with potential adverse mental health effects.
Learning Objectives:
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.