Expanded care for enhanced living: Behavioral health outcomes of HIV/AIDS patients enrolled in the ExCEL project

Background: Researchers have described a wide range of psychological and psychosocial sequelae associated with HIV/AIDS. Psychological complications include distress, anger, guilt, bereavement, and the full spectrum of psychiatric disorders during the course of living with HIV/AIDS. Project EXCEL is a five-year service delivery and evaluation study funded by SAMHSA. El Rio Santa Cruz Neighborhood Health Center's Special Immunology Associates is delivering and evaluating a culturally competent mental health service delivery model for HIV infected persons integrated within primary medical care setting. The objective of the study is to support and improve the mental health status of HIV infected persons.

Methods: The study is a quasi-experimental, longitudinal, repeated measures design. Patients receiving mental health services are enrolled into the study and a comprehensive bio-psychosocial assessment, Global Appraisal of Individual Need (GAIN) is completed at study intake and every 90 days for 12 months. The GAIN has eight core sections (background, substance use, physical health, risk behaviors, mental health, environment, legal, and vocational). Service utilization is captured electronically via billing software.

Results: Preliminary outcome analysis (n=91) using paired T-tests indicate positive outcomes at 3-months for patients including reductions in Health Distress (p<.001), Sex Risk (p<.001), Internal Mental Distress (and 4 subscales) (p<.001), Behavior Complexity (and 3 subscales) (p<.001) and Personal Sources of Stress (p<.05). Service utilization (HIV primary care and behavioral health services) as correlates are also discussed.

Conclusion: The addition of behavioral health services within a primary care setting facilitates service utilization and evidences positive outcomes for patients living with HIV/AIDS.