Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave, Room 379, St Louis, MO 63104. Email:
Am J Manag Care. 2020 Aug;26(8):357-360. doi: 10.37765/ajmc.2020.44072.
HIV prevention strategies prioritize medication adherence among people living with HIV (PLWH). Of the 1.1 million PLWH in the United States, more than two-fifths are not virally suppressed and thus experience increased morbidity and mortality as well as transmission risk. Integrated care models are meant to address these gaps and often cite the importance of mental health care services (MHCS). However, research into the impact of integrating MHCS has been limited to those in homogenous treatment.
This study used an analytic observational cross-sectional design to achieve the above objectives.
This study utilized a cross-sectional survey aimed to identify needs among PLWH in the Midwestern region of the United States and to stratify by both MHCS need and receipt. The survey, administered throughout 2018 in 12 HIV service organizations, was completed by PLWH receiving different supportive services. Comparative logistic regression models were calculated to identify the likelihood of nonadherence based on both MHCS receipt and need.
Of the 537 survey respondents, 20% reported receiving integrated MHCS, 8% reported needing but being unable to receive MHCS, and 72% reported not needing or receiving MHCS. Overall, 50% of the sample reported missing at least some HIV medication within the past 30 days. Individuals who needed but did not receive MHCS were more likely to report treatment nonadherence. No significant difference in adherence was identified between those who received MHCS and those who did not need MHCS.
Results suggest that continued assessment of needs and integration of MHCS into HIV care improves the likelihood of medication adherence. Further, our study highlights how systematically asking PLWH about their needs and connecting them to services may critically affect HIV management.
艾滋病毒预防策略优先考虑艾滋病毒感染者（PLWH）的药物依从性。在美国，110 万 PLWH 中有超过五分之二的人没有被抑制病毒，因此他们的发病率和死亡率以及传播风险都增加了。综合护理模式旨在解决这些差距，并且经常引用心理健康护理服务（MHCS）的重要性。然而，将 MHCS 纳入的研究仅限于同质治疗。
本研究采用分析性观察性横断面设计来实现上述目标。
本研究利用横断面调查来确定美国中西部地区 PLWH 的需求，并根据 MHCS 的需求和获得情况进行分层。该调查于 2018 年在 12 个 HIV 服务组织中进行，由接受不同支持服务的 PLWH 完成。计算比较逻辑回归模型，以确定基于 MHCS 获得和需求的不依从的可能性。
在 537 名调查受访者中，20%报告接受了综合 MHCS，8%报告需要但无法获得 MHCS，72%报告不需要或没有获得 MHCS。总体而言，50%的样本报告在过去 30 天内至少漏服了一些 HIV 药物。需要但未获得 MHCS 的个体更有可能报告治疗不依从。接受 MHCS 和不需要 MHCS 的个体之间在依从性方面没有显著差异。
结果表明，继续评估需求并将 MHCS 纳入 HIV 护理可提高药物依从性的可能性。此外，我们的研究强调了如何系统地询问 PLWH 他们的需求并为他们提供服务可能会对 HIV 管理产生重大影响。
