Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #107951

Brian Wells Pence, MPH¹, Bradley N. Gaynes, MD, MPH², Kathryn Whetten, PhD³, Joseph J. Eron, MD², and William C. Miller, MD, PhD, MPH⁴. (1) Department of Epidemiology, University of North Carolina at Chapel Hill, CB # 7435, Chapel Hill, NC 27599-7435, 919-968-4131, bpence@unc.edu, (2) Cecil Sheps Center for Health Services Research, University of North Carolina, CB # 7590, Chapel Hilll, NC 27599, (3) Health Inequalities Program, Duke University, PO Box 90253, Durham, NC 27705, (4) Department of Epidemiology, UNC School of Public Health, CB#7435 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7435

Background: Substance abuse (SA) and mental illness (MI) commonly co-occur with HIV infection in the United States and have important implications for clinical management of HIV/AIDS. Yet these comorbidities often go undiagnosed and untreated due in part to a lack of practical, validated screening tools. Setting: HIV clinic in large university teaching hospital. Methods: The 16-item SA/MI Symptoms Screener (SAMISS) was designed to identify patients with SA/MI in busy HIV clinics. Consecutive consenting new HIV+ patients completed first the SAMISS and then a reference standard, the Structured Clinical Interview for DSM-IV Diagnoses (SCID), to establish SA/MI diagnoses. Results: 185 patients enrolled in the study and 152 (82%) completed follow-up. 20% (30/152) had a SA diagnosis and 42% (62/145) had a MI diagnosis in the past year. 38% (58/152) screened positive for SA and 69% (101/145) screened positive for MI on the SAMISS. The SAMISS had a sensitivity of 87% (95% CI: 75–99%) for SA and 94% (87–100%) for MI, and a specificity of 74% (66–82%) for SA and 49% (39–60%) for MI. MI specificity decreased with an increasing number of HIV symptoms reported (0–24% of symptoms endorsed: specificity = 64%; 25–49%: 41%; 50–100%: 25%; p=0.02). Conclusion: The SAMISS functioned well as a first-line screening tool for SA/MI in this HIV clinic population. It missed very few true cases and was easily incorporated into a busy clinical setting. Screen-positives require a more rigorous evaluation to confirm their diagnosis.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Articulate the importance of identifying substance abuse and mental illness in HIV clinical settings
• Describe the parameters used to evaluate screening tools
• Develop a plan to implement substance abuse and mental illness screening in an HIV clinical setting

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.