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.
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

University of Virginia Health System

Related Hiv Articles:

Defective HIV proviruses reduce effective immune system response, interfere with HIV cure
A new study finds defective HIV proviruses, long thought to be harmless, produce viral proteins and distract the immune system from killing intact proviruses needed to reduce the HIV reservoir and cure HIV.
1 in 7 people living with HIV in the EU/EEA are not aware of their HIV status
Almost 30,000 newly diagnosed HIV infections were reported by the 31 European Union and European Economic Area (EU/EEA) countries in 2015, according to data published today by ECDC and the WHO Regional Office for Europe.
Smoking may shorten the lifespan of people living with HIV more than HIV itself
A new study led by researchers at Massachusetts General Hospital finds that cigarette smoking substantially reduces the lifespan of people living with HIV in the US, potentially even more than HIV itself.
For smokers with HIV, smoking may now be more harmful than HIV itself
HIV-positive individuals who smoke cigarettes may be more likely to die from smoking-related disease than the infection itself, according to a new study published in the Journal of Infectious Diseases.
Patients diagnosed late with HIV infection are more likely to transmit HIV to others
An estimated 1.2 million people live with HIV in the United States, with nearly 13 percent being unaware of their infection.
The Lancet HIV: New HIV infections stagnating at 2.5 million a year worldwide
A major new analysis from the Global Burden of Disease 2015 study, published today in The Lancet HIV journal, reveals that although deaths from HIV/AIDS have been steadily declining from a peak in 2005, 2.5 million people worldwide became newly infected with HIV in 2015, a number that hasn't changed substantially in the past 10 years.
NIH scientists discover that defective HIV DNA can encode HIV-related proteins
Investigators from the National Institutes of Health have discovered that cells from HIV-infected people whose virus is suppressed with treatment harbor defective HIV DNA that can nevertheless be transcribed into a template for producing HIV-related proteins.
Study examines risk of HIV transmission from condomless sex with virologically suppressed HIV infection
Among nearly 900 serodifferent (one partner is HIV-positive, one is HIV-negative) heterosexual and men who have sex with men couples in which the HIV-positive partner was using suppressive antiretroviral therapy and who reported condomless sex, during a median follow-up of 1.3 years per couple, there were no documented cases of within-couple HIV transmission, according to a study appearing in the July 12 issue of JAMA, an HIV/AIDS theme issue.
HIV vaccine design should adapt as HIV virus mutates
Researchers from UAB, Emory and Microsoft demonstrate that HIV has evolved to be pre-adapted to the immune response, worsening clinical outcomes in newly infected patients.
Charlie Sheen's HIV disclosure may reinvigorate awareness, prevention of HIV
Actor Charlie Sheen's public disclosure in November 2015 that he has the human immunodeficiency virus (HIV) corresponded with the greatest number of HIV-related Google searches ever recorded in the United States, according to an article published online by JAMA Internal Medicine.

Related Hiv Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#SB2 2019 Science Birthday Minisode: Mary Golda Ross
Our second annual Science Birthday is here, and this year we celebrate the wonderful Mary Golda Ross, born 9 August 1908. She died in 2008 at age 99, but left a lasting mark on the science of rocketry and space exploration as an early woman in engineering, and one of the first Native Americans in engineering. Join Rachelle and Bethany for this very special birthday minisode celebrating Mary and her achievements. Thanks to our Patreons who make this show possible! Read more about Mary G. Ross: Interview with Mary Ross on Lash Publications International, by Laurel Sheppard Meet Mary Golda...