Interdisciplinary HIV care in a changing healthcare environment in the USA

Ojikutu, Bisola; Holman, Jeremy; Kunches, Laureen M.; Landers, Stewart; Perlmutter, Dianne; Ward, Melina; Fant, Gregory; Hirschhorn, Lisa R.

doi:10.1080/09540121.2013.855299

Cited by 35 publications

(21 citation statements)

References 5 publications

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“…While many HIV specialty clinics provide co-located mental health, drug treatment and other supportive services,[31] low rates of screening, counseling and referrals by clinicians remains a challenge. [28,29] Screening for risk behaviors and providing prevention messages are limited by time constraints and competing clinical priorities even where these interventions are the standard of care for a clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Behavioral and Other Characteristics Associated with HIV Viral Load in an Outpatient Clinic

Sacamano

Farley

2016

PLoS ONE

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Persons living with HIV (PLWH) who are engaged in care, yet not virally suppressed, represent a risk for transmission and opportunity for risk reduction interventions. This study describes characteristics of an outpatient clinic cohort of PLWH by laboratory confirmed viral suppression status and examines associations with demographics and sexual and drug use behaviors gathered through questionnaire. From a sample of 500 clinic patients, 438 were prescribed antiretroviral treatment (ART) and 62 were not. Among the 438 on ART, 72 (16.4%) were not virally suppressed at the most recent lab draw. Compared to individuals with a suppressed viral load, those that were unsuppressed were more likely to: be black (79.2% vs. 64.2%; p = 0.014); earn below $25,000/year (88.9% vs. 65.0%; p < 0.001); be of a younger age (47.8 vs. 50.0 mean years; p = 0.009); be on opiate substitution (14.1% vs. 6.3%; p = 0.023); and acknowledge poly-substance (38.9% vs. 24.4%; p = 0.012) and excessive alcohol use (13.9% vs. 6.0%; p = 0.019). Conversely, a smaller proportion of those with an unsuppressed viral load had multiple sex partners in the previous 30 days (39.8% vs. 58.5%; p = 0.003). In multivariable regression of those on ART, the prevalence of an unsuppressed viral load was 3% lower with each increasing year of age (aPR: 0.97; 95% CI: 0.95, 0.99) and 47% lower with income over $25,000/year (aPR: 0.33; 95% CI: 0.16, 0.70). In a separate analysis of all 500 subjects, ART was less frequently prescribed to blacks compared to whites, heterosexuals, those with lower education and income, and persons with active substance use. Findings confirm that a large proportion of PLWH and engaged in care were not virally suppressed and continued behaviors that risk transmission, indicating the need for screening, prevention counseling and access to ancillary services to lower the incidence of HIV infections.

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Section: Discussionmentioning

confidence: 99%

Behavioral and Other Characteristics Associated with HIV Viral Load in an Outpatient Clinic

Sacamano

Farley

2016

PLoS ONE

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“…Interestingly, the early years of the HIV epidemic were characterized by interdisciplinary care at many centers due to the manifold and often baffling manifestations of AIDS [40 ▪▪ ,41]. Experts in neurology, psychiatry, oncology and ophthalmology – often with a strong interest in or passion for working with PLWH – collaborated closely HIV primary care providers.…”

Section: Introductionmentioning

confidence: 99%

Patient-centered care for people living with multimorbidity

Boyd

Lucas

2014

Current Opinion in HIV and AIDS

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Purpose of review The purpose of this review is to consider a patient-centred approach to the care of people living with HIV (PLWH) who have multimorbidity, irrespective of the specific conditions. Recent findings Interdisciplinary care to achieve patient-centred care for people with multimorbidity is recognized as important, but the evaluation of models designed to achieve this goal are needed. Key elements of such approaches include patient preferences, interpretation of the evidence, prognosis as a tool to inform patient-centred care, clinical feasibility and optimization of treatment regimens. Summary Developing and evaluating the best models of patient-centred care for PLWH who also have multimorbidity is essential. This challenge represents an opportunity to leverage the lessons learned from the care of people with multimorbidity in general, and vice versa.

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“…Another model is integrated complex case management, which involves the longitudinal, relationship-based use of biopsychosocial and health system-based care plans that are complexity-focused, with few handoffs, and escalation of care as well as discharge based on clinical, functional, and cost outcome measurement [ 68 ]. Application of these models in the HIV field is relatively new, but they offer great promise [ 74 – 76 ], especially when designed to also address HIV-positive women’s key structural determinants including violence against women and economic insecurity [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Comorbidity, and Correlates of Psychiatric and Substance Use Disorders and Associations with HIV Risk Behaviors in a Multisite Cohort of Women Living with HIV

et al. 2018

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We used the World Health Organization’s Composite International Diagnostic Interview to determine the prevalence, comorbidity, and correlates of lifetime and 12-month behavioral health disorders in a multisite cohort of 1027 women living with HIV in the United States. Most (82.6%) had one or more lifetime disorders including 34.2% with mood disorders, 61.6% with anxiety disorders, and 58.3% with substance use disorders. Over half (53.9%) had at least one 12-month disorder, including 22.1% with mood disorders, 45.4% with anxiety disorders, and 11.1% with substance use disorders. Behavioral health disorder onset preceded HIV diagnosis by an average of 19 years. In multivariable models, likelihood of disorders was associated with women’s race/ethnicity, employment status, and income. Women with 12-month behavioral health disorders were significantly more likely than their counterparts to engage in subsequent sexual and substance use HIV risk behaviors. We discuss the complex physical and behavioral health needs of women living with HIV.

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Interdisciplinary HIV care in a changing healthcare environment in the USA

Cited by 35 publications

References 5 publications

Behavioral and Other Characteristics Associated with HIV Viral Load in an Outpatient Clinic

Behavioral and Other Characteristics Associated with HIV Viral Load in an Outpatient Clinic

Patient-centered care for people living with multimorbidity

Prevalence, Comorbidity, and Correlates of Psychiatric and Substance Use Disorders and Associations with HIV Risk Behaviors in a Multisite Cohort of Women Living with HIV

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