ADHERENCE TO ANTIRETROVIRAL THERAPY (ART) FOR HIV-INFECTED
PERSONS WITH SEVERE MENTAL DISORDERS (PSMD)
Colson PW, Rita A, Watkins A, Staggers R, Mannheimer S, El-Sadr W. Harlem
Adherence to Treatment Study, Division of Infectious Diseases, Harlem Hospital Center
and Columbia University, New York, NY.
Introduction
Growing numbers of PSMD have acquired HIV. Most HIV interventions for PSMD
emphasize prevention and offer little to help already-infected PSMD cope with
challenging ART regimens. 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. While ART has improved health
outcomes, many clinicians are reluctant to prescribe ART to PSMD.
Organizational Actions
Several years ago, concerns about HIV among PSMD led to meetings between the
Department of Psychiatry and Division of Infectious Diseases. Several actions were
proposed. One such action entailed co-location of staff: an internist joined the staff of
Psychiatry to address physical concerns, while a psychiatrist provided weekly consults on
psychiatric issues in the Infectious Disease Clinic. Further communication between the
two departments has occurred through Grand Rounds and journal club presentations, and
shared trainings.
Exploratory Phase
Methods
Individual and group interviews were conducted with 14 HIV+ PSMD who are patients
of the Psychiatry Department and/or the Infectious Diseases Clinic in a New York City
hospital. Topics included experiences with psychiatric and ART regimens separately, comanagement of regimens, services received from the two departments, service needs, and
personal concerns such as privacy and stigma.
Results
Respondents were greatly affected by the stigmatization of the two conditions. Many
openly acknowledged one while refusing to disclose the other. Similarly, most
respondents received services from either Psychiatry or Infectious Diseases and avoided
association with the other. Privacy concerns inhibited service coordination between the
two departments. Other barriers were caused by respondents seeking services outside the
hospital, without informing the doctor. Because of concerns about side effects, drug
interactions, and toxicity, some delayed seeking treatment. Co-management of the two
regimens was assisted by the use of alarms and pill boxes, and through support from
family members or workers.
Intervention Phase
PSMD with HIV disease need special supports to cope with the demands of these
difficult regimens. Patients referred from Psychiatry are currently being enrolled in the
Harlem Adherence to Treatment Study (HATS), a peer support intervention to increase
adherence to HIV medications. Based on Prochaska’s Stages of Change model, the
intervention offers support from peer workers, caseworkers, and health educators.
Approximately 10 patients are currently enrolled in HATS and will receive intervention
services for one year. In addition to testing the impact of the intervention, the
investigators will explore factors (e.g., social support, service utilization, substance use,
adherence to psychiatric medications) which are associated with adherence and nonadherence in this population. The HATS intervention serves as an example of the sort of
innovative models needed to help PSMD cope with both HIV disease and their
psychiatric illness and to assist them in adherence with treatments for both conditions.
Contact Information:
For more information, contact Dr. Paul Colson, Charles P. Felton National Tuberculosis
Center at Harlem Hospital, 2238 Fifth Ave., 1st Floor, New York, NY 10037. phone:
(212) 939-8241; email: pwc2@columbia.edu