Individuals with severe mental illness are notoriously difficult to engage and retain in HIV care due to fragmented health care policies and systems that perpetuate stigma, according to an electronic poster presentation today at AIDS 2020.
Individuals with severe mental illness (SMI) have a 10-fold greater likelihood of HIV infection, and they are notoriously difficult to engage and retain in HIV care due to fragmented health care policies and systems that perpetuate stigma. Solutions to remedy this were presented in the electronic poster “Designing Health Care Policy and Care Systems to Reach and Retain Those With Severe Mental Illness in HIV Prevention and Care Efforts: Insights From Five US States,” at AIDS 2020, this year’s virtual rendering of the International AIDS Conference.
“We sought to identify solutions at the health care delivery system level, as well as policies at the state and local level, that might affect HIV-related health outcomes for this key population and inform 'Ending the HIV Epidemic's efforts,” the authors stated.
The team comprised investigators from the University of California, San Francisco; the Kaiser Family Foundation; Rutgers University; and Columbia University, whose case-study design involved 27 semi-structured interviews of key stakeholders (eg, academics, state and county-level public administrators in HIV and/or behavioral health, service providers at no-profit agencies) from 5 states between September 2018 and December 2019:
Among the many interview topics addressed, and discussed, were HIV testing and treatment policies, the organization of SMI and HIV health care systems, care integration efforts, and electronic data sharing.
The authors found several main obstacles to increasing care among individuals with SMI:
“Case studies in five high HIV prevalence states yield important insights into health care delivery systems and policies that improve HIV-related health outcomes for those with SMI,” they concluded.
So what can be done to prevent those with SMI and HIV from falling through the care gap? Key ideas include the following:
More money also is needed, and the authors suggested that in order to incentivize engaging people with SMI in HIV care, making funding through state block grants dependent on offering HIV testing, especially if a behavioral health community clinic, could be a solution. The authors also believe in making HIV screening a routine part of care at emergency departments and drug treatment facilities, providing assistance to those getting out of jail or prison by linking them to care programs as they reenter civilian life, and sharing electronic health records.