Nav: Home

Successful HIV effort prompts call for clinics to expand mental health services on site

May 21, 2019

Increasing access to mental health services improves HIV outcomes among vulnerable patients, a new study from the University of Virginia School of Medicine suggests. Based on their findings, the researchers are urging HIV clinics to expand their on-site mental health services.

"With the president's 'Ending the HIV Epidemic' [goal], we need to be identifying evidence-based programs and policies that help improve HIV outcomes. This study adds to the evidence that co-located mental health services, which includes psychiatry, psychology and substance-use counseling, can contribute to improved HIV viral suppression, which is a key health metric for HIV care," said researcher Kathleen McManus, MD, of UVA's Division of Infectious Diseases and International Health. "We hope that this work will encourage more Ryan White HIV/AIDS clinics to seek support for co-located mental health and substance use counseling services."

Improving HIV Care

Seeking to improve outcomes for people living with HIV, UVA's Ryan White Clinic expanded its mental health services in 2013, increasing access to psychiatry and psychology services and substance-use counseling. Between 2012 and 2014, UVA more than doubled the number of clinic patients receiving mental healthcare. Mental health visits at the clinic increased from 385 in 2012 to 941 in 2013 and 1,183 in 2014. (UVA's ability to expand the mental health offerings was made possible by funding from the Health Resources and Services Administration Ryan White HIV/AIDS Program.)

Researchers then compared how patients fared before and after the expansion. They compared one group of 130 patients who initiated mental healthcare before the expansion and another group of 181 patients who initiated mental healthcare after the expansion to get a snapshot of who was gaining access when the availability of mental health services increased. They also examined the HIV outcomes of the patients in the latter group both before and after the expansion.

They found:
  • Patients who had access to the expanded mental healthcare achieved better HIV outcomes after establishing care with a mental health provider. The rate of viral suppression - when the virus is undetectable in the body, a key benchmark for patients' treatment and overall health - increased from 57 percent to 88 percent.
  • When mental health care services were expanded, the patients who gained access to these services were not doing as well as people who had already established mental health care. The patients who gained access were more likely to have AIDS with a low CD4 count, which shows how the immune system is functioning. They were also more likely to have a detectable viral load, meaning that their health was not optimized and that they could transmit HIV to someone else.
  • Older and white patients benefited more from the increased access to mental healthcare than did other patients.
  • Younger and black patients were less likely to achieve viral suppression after initiating mental healthcare, prompting the UVA researchers to question whether changes are needed in how care and other services are provided to those patients.
  • The expanded mental healthcare did not significantly change patients' engagement in their HIV care measured by attending at least two HIV medical appointments within a year.
  • After the expansion, more patients were diagnosed as having substance use-related diagnoses, possibly because of increased awareness and identification by the mental health providers.
Describing their findings in a new article in the scientific journal Open Forum Infectious Diseases, the UVA researchers wrote that expanding mental healthcare at HIV clinics across the country could help the U.S. reach the goal of viral suppression among 90 percent of people with HIV. That would help prevent further transmission of the disease, they noted. "It is an opportunity to improve viral suppression outcomes for vulnerable populations, and this is pressing given the worsening of the opioid and substance-use crises," they concluded.

The researchers noted that this was a small, retrospective study and called for additional research to assess if there is a causal relationship between increased access to mental healthcare and viral suppression.
-end-
About the Study

The study's authors were Raina Aggarwal, Michael Pham, Rebecca Dillinghamand McManus. McManus reported stock ownership in Gilead Sciences Inc., a biopharmaceutical company that manufactures medicines for HIV and other conditions.

The research was supported by the Agency for Healthcare Research and Quality, grant F32HS024196; the National Institutes of Health's National Institute of Allergy and Infectious Diseases, grant K08AI136644; an Infectious Diseases Society of America Foundation's Medical Scholars Program award; and UVA's Translational Health Research Institute of Virginia (THRIV).

To keep up with the latest medical research news from UVA, subscribe to the Making of Medicine blog at http://makingofmedicine.virginia.edu.

University of Virginia Health System

Related Hiv Articles:

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).
Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.
Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.
The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.
The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.
Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.
NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.
First ever living donor HIV-to-HIV kidney transplant
For the first time, a person living with HIV has donated a kidney to a transplant recipient also living with HIV.
The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.
Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.
More HIV News and HIV Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.