HIV Treatment Adherence among Persons with Severe Mental Illness

Principal Investigator: Paul Colson, Ph.D., (Charles P. Felton National Tuberculosis Center at Harlem Hospital); Co-Principal Investigators: Sharon Mannheimer, M.D., Wafaa El-Sadr, M.D., MPH (Harlem Hospital); D.A. Johnson, (NYC OMH Office of Recipient Affairs)

PROJECT GOALS

Project goals are to:

• identify factors that relate to treatment adherence for HIV antiretroviral medications among PSMD, and adapt instruments to measure these factors;
• implement a model intervention for PSMD with HIV, incorporating peer support and based on the Transtheoretical Model of Change   theory in a small sample and qualitatively assess client satisfaction; and 
• test our ability to collect data over time on adherence factors, adherence, and HIV outcomes among PSMD with HIV;
• seek NIH fundings for a randomized clinical trial.
  
  

RESEARCH ACTIVITIES AND RESULTS

Methods: The exploratory phase of this project, which used open-ended interviews with PSMD with HIV infection to identify factors that would support adherence to antiretroviral medication for HIV has been completed. The second phase of the project, enrollment of PSMD with HIV infection into the Harlem Adherence to Treatment Study (HATS) through the Harlem Hospital Dept. of Psychiatry was operational from Oct. 2002 to March 2003. The HATS intervention focuses on improving adherence to antiretroviral medications through support from a peer worker, health educator, and case manager. Only six PSMD referred directly from the Department of Psychiatry were enrolled; however, there was substantial enrollment of PSMD into the HATS study through the infectious disease clinics at Harlem Hospital. With this sample, the investigators tested an extensive assessment battery including self, peer and provider assessment of medication adherence; stage of change and attitudes toward behavior change, social support, service utilization, life events, HIV knowledge and attitudes, substance use, quality of life, literacy, depression, psychosis, viral load and CD4 counts. These measures have proven to be useful and practical in this setting and this population. Due to the limited enrollment from the Department of Psychiatry, Center funding for this aspect of the project was withdrawn. However, information about this pilot project and the prevalence of mental illness in the overall HATS study has been presented at several research conferences.

SIGNIFICANCE OF FINDINGS/ POLICY IMPLICATIONS

Incidence of HIV among PSMD,  particularly among African Americans, is high.  Mental health problems may interfere with an individual’s ability and motivation to follow treatment regimens as HIV regimens are demanding, especially in conjunction with psychotropic regimens. Finding methods to encourage adherence to these treatment plans should translate into far better outcomes for PSMD with HIV.

PLANS

Participants who were enrolled through the Department of Psychiatry will receive twelve months of HATS services. The amount of undiagnosed mental disorder in the HATS sample indicates a need for psychiatric screening in the primary care setting and for support for PSMD with HIV to adhere to antiretroviral therapy. We plan to submit an R01 application to the National Institute for Drug Abuse for the September 1 deadline. The proposed project will be based, in part, on results from the Center funded project that were used to adapt the HATS intervention for PSMD and MICA patients.

Entered: July 2000

Updated: July 1, 2003