Recruitment, engagement, and retention of people living with HIV and co-occurring mental health and substance use disorders.

People living with HIV/AIDS who have both a co-occurring mental health diagnosis and a substance use disorder (individuals with triple diagnoses) frequently do not receive adequate treatment for one or more of their illnesses. Poverty, risky behaviours, vacillating motivation, and cognitive impairments are additional problems facing many individuals with triple diagnoses. In many communities the service system is inadequately prepared to serve this population. Treatment barriers include stigma associated with the three illnesses, separate funding streams, and lack of co-ordination between medical, mental health, and substance abuse treatment facilities. This paper discusses strategies for recruiting, engaging, and retaining individuals with triple diagnoses in both treatment and research. Recruitment strategies should be directed at both professionals and individuals with triple diagnoses themselves. Recruiting and engaging these individuals in treatment requires that comprehensive services be provided on a 24-hour basis in a flexible and culturally competent manner. A team approach is often the most effective way of providing such services. Retaining individuals with triple diagnoses in a longitudinal research study requires multiple strategies including the collection of detailed tracking information, outreach workers, and financial incentives for completing the interviews.