Literature on integrated HIV care: a review

Abstract

With a significant proportion of HIV-infected patients now presenting with co-occurring substance abuse disorders and mental disorders, interest in integrated HIV care is growing. However, no review of integrated HIV care has been conducted. Using relevant key word searches of the Medline and Psychlit databases, the authors identified about 450 publications. The few evaluations of integrated models tended to focus on measurements of engagement and retention in medical care, and their findings indicated an association between integrated HIV care and increased service utilization. No random assignment controlled studies were identified, except in the peripheral area of integrated care (without HIV primary care) for persons with co-occurring substance abuse disorders and mental disorders. The majority of reviewed articles described integrated models operating in the field and various aspects of implementation and sustainability. Overall, they supported use of a wide range of primary and ancillary services delivered by a multidisciplinary team that employs a 'biopsychosocial' approach. Despite the lack of scientific knowledge regarding the effects of integrated HIV care, those wanting to optimize treatment for patients with multiple interacting disorders can gain useful and practical knowledge from this literature.

Attendance at an outpatient follow-up clinic by HIV-positive psychiatric patients initiated on ART as inpatients

“…Integrated care has been shown to improve outcomes, with a number of different models of mental health and HIV integrated programmes described in the literature. [11] The rate of attendance found at our integrated clinic is comparable with rates of first clinic appointment attendance post discharge from psychiatric hospitalisation internationally. [13,14] There are no data with which to compare our rate of attendance with early attendance post hospitalisation at HIV treatment centres in order to evaluate the effectiveness of the integrated model in terms of improving outcomes.…”

“…[10] Integrated HIV and mental healthcare might result in improved rates of clinic attendance, by providing personalised follow-up, specifically tailored to the needs of those with a mental illness as well as HIV infection. [11] In a previous study conducted at the Luthando clinic, Wagner et al [12] suggest that rates of retention in care at the Luthando Clinic are similar to those reported for general HIV clinics, and higher than expected for psychiatric clinics, with 24.8% of patients lost to followup (LTFU), defining LTFU as failure to attend the clinic for more than 6 months.…”

Integrating behavioral health with medical services: Lessons from HIV care.

“…In line with this goal is the elaboration of integrated HIV health service models that include mental health programs (for review, see Soto, Bell, & Pillen, 2004). Given the disproportionate impact of the United States HIV epidemic in communities of color, with the greatest burden among African Americans (Centers for Disease Control, 2011;Lansky, Brooks, DiNenno, Heffelfinger, Hall, & Mermin, 2010), ensuring that clinical models are relevant to the service needs of these communities is especially important.…”

Management of mental health disorders in HIV-positive patients

“…• SMDs lead to an increased risk of acquiring and transmitting HIV • SMDs may impact adherence to psychiatric treatment and ART • HIV disease progression can be associated with secondary psychiatric disorders, which often improve with ART • Integrated care of both conditions improves outcomes [7] • Successful ART is more likely if there is:…”

“…It is also intended to heighten HIV clinicians' awareness of the need to integrate HIV and mental healthcare within their daily practice. [7] The following conditions and issues are addressed here:…”