Concurrent Examination of Well-Being and Biomarkers among HIV+ Persons with Mental Illness

The heightened risk of persons with serious mental illness to contract and transmit human immunodeficiency virus is a public health problem that has been receiving increased attention.  In a randomized trial, we tested the effectiveness of a community-based advanced practice nurses intervention called PATH (Preventing AIDS Through Health) to promote adherence to HIV and psychiatric treatment regimens.  A total of 238 HIV-positive subjects with a co-occurring mental illness who were in treatment at community HIV provider agencies from 2004-2009 were recruited for longitudinal study. Participants in the PATH intervention group were assigned an advanced practice nurse who provided community-based care management at a minimum of one visit/week and coordinated their medical and mental healthcare for one year, with a 24 month follow-up to monitor radiating effects or decay of the intervention.   Control participants received treatment as usual.  The main outcome measures included both biomarkers as well as behavioral self-reports.  HIV Viral load and CD4 counts were gathered  at baseline, 12 and 24 months, and health-related quality of life measures (SF-12 Mental and Physical Health)were gathered  at baseline, 3, 6, 12, and 24 months.  These data were analyzed using a parallel process latent growth curve model using three data points for biomarkers (baseline, 12 & 24 months) and five data points for health related quality of life (baseline, 3, 6, 12, & 24 months).  The results  show moderate to excellent fit for modeling changes in CD4, viral load, as well as mental and physical SF-12 subscales.  This project demonstrates the effectiveness of a community-based tailored adherence intervention to improve outcomes of individuals with HIV/SMI. HIV+ persons with SMI can successfully adhere to treatment and achieve improvements in health-related quality of life and biomarker health status indicators.  The latent growth curve modeling approach shows great promise as an analytic strategy for simultaneously evaluating longitudinal changes in physical health and health related quality of life and well-being .