Abstract
Low-barrier care is one model of a differentiated service delivery approach for people with HIV (PWH) who are not engaged in conventionally-organized HIV care. Although psychiatric and substance use disorders are common among patients in low-barrier clinics, approaches to behavioral health service delivery within this context have not been well-described. We conducted a descriptive analysis using retrospective review of medical records to evaluate substance use and psychiatric comorbidities and receipt of behavioral health services among patients in the Max Clinic in Seattle, Washington. Among 227 patients enrolled from 2015 to mid-2020, most had a history of hazardous substance use (85%), a psychiatric diagnosis (69%) or unstable housing (69%) documented in the medical record. Less than half of patients referred for depression treatment (33%) or for opioid use disorder treatment (40%) completed even one specialty care visit. More effective approaches are needed to engage patients in behavioral health services within the context of low-barrier HIV care.
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Acknowledgements
The authors would like to acknowledge the Max Clinic care team and Julie Sako, who performed some chart review for this project. Research reported in this manuscript was supported by the following: the National Institute On Drug Abuse of the National Institutes of Health under Award Number 1R25DA050985; the IDSA Foundation and HIV Medicine Association (HIVMA) Grants for Emerging Researchers/Clinicians Mentorship Program (G.E.R.M.) Grant, the University of Washington Center for AIDS Research (CFAR), an National Institutes of Health funded program [P30AI027757]; and the University of Washington Behavioral Research Center for HIV, a NIMH-funded program (P30 MH123248). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding
This research was supported by the National Institute On Drug Abuse of the National Institutes of Health (Award Number 1R25DA050985); the IDSA Foundation and HIV Medicine Association (HIVMA) Grants for Emerging Researchers/Clinicians Mentorship Program (G.E.R.M.) Grant (to EA); the University of Washington Center for AIDS Research (CFAR), an National Institutes of Health funded program([P30AI027757); the University of Washington Behavioral Research Center for HIV, a NIMH-funded program (P30 MH123248). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Eden E. Altwies: funding acquisition, conceptualization, chart review, data curation and analysis, writing – original draft preparation and revision. Kaitlin A. Zinsli: data curation, data analysis, writing – original draft preparation and revision. Lydia Chwastiak: conceptualization, writing – reviewing and editing. Judith I. Tsui: funding acquisition, conceptualization, writing – reviewing and editing. Elenore P. Bhatraju: conceptualization, writing – reviewing and editing. Meena S. Ramchandani: writing – reviewing and editing. Matthew R. Golden: writing – reviewing and editing. Julia C. Dombrowski: conceptualization, supervision, writing - original draft preparation and revision.
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Financial interests: JCD has participated in research with materials donated by Hologic, Cepheid and Mayne Pharmaceuticals. MSR is a stockholder at Gilead Sciences and Merck & Co. Non-financial interests: None.
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Altwies, E.E., Zinsli, K.A., Chwastiak, L. et al. Substance Use and Mental Health Comorbidities and Receipt of Specialty Care Among Patients Enrolled in a Low-Barrier HIV Clinic. AIDS Behav 27, 3952–3960 (2023). https://doi.org/10.1007/s10461-023-04110-3
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DOI: https://doi.org/10.1007/s10461-023-04110-3