Full Service
A New Study Suggests That Expanding Mental Health Services Can Improve HIV Care
by Larry Buhl

Achieving better HIV outcomes among vulnerable patients could be as easy as providing additional mental healthcare, researchers at the University of Virginia School of Medicine suggest.

With funding from the Health Resources and Services Administration Ryan White HIV/AIDS Program, in 2013, the med school’s Ryan White Clinic increased access to psychiatry and psychology services and substance-use counseling. Between 2012 and 2014, UVA more than doubled the number of clinic patients receiving mental healthcare. Mental health visits at the clinic increased from 385 in 2012 to 941 in 2013 and 1,183 in 2014.

Researchers then considered how patients fared before and after the expansion, looking at one group of 130 patients who initiated mental healthcare before the expansion and another group of 181 patients who initiated mental healthcare after the expansion to get a snapshot of who was gaining access when the availability of mental health services increased. They also looked the HIV outcomes of the patients in the latter group, both before and after the expansion.

They found:

• Patients who had access to the expanded mental healthcare achieved better HIV outcomes after establishing care with a mental health provider. The rate of viral suppression increased from fifty-seven percent to eighty-eight percent among that group.

• When mental healthcare services were expanded, the patients who gained access to these services were not doing as well as people who had already established mental healthcare. The patients who gained access were more likely to have an AIDS diagnosis with a low CD4 count. They were also more likely to have a detectable HIV viral load, meaning that their health was not optimized and that they could transmit HIV to someone else.

• Older and white patients benefited more from the increased access to mental healthcare than did other patients. Younger and black patients were less likely to achieve viral suppression after initiating mental healthcare.

• The expanded mental healthcare did not significantly change patients’ engagement in their HIV care, as measured by attending at least two HIV medical appointments within a year.

• After the expansion, substance use-related diagnoses increased from one-quarter to one-third, possibly because of increased awareness and identification by the mental health providers. The number of acute stress diagnoses doubled, again, possibly due to increased awareness.

In sharing their findings in an article in the scientific journal Open Forum Infectious Diseases, the UVA researchers wrote that expanding mental healthcare at HIV clinics across the country could help the U.S. reach the goal of viral suppression among ninety percent of people with HIV. “It is an opportunity to improve viral suppression outcomes for vulnerable populations, and this is pressing given the worsening of the opioid and substance-use crises,” they concluded.

Researcher Dr. Kathleen McManus of UVA’s Division of Infectious Diseases and International Health told A&U that the study adds to the growing body of evidence that co-located mental health services—including psychiatry, psychology and substance-use counseling—can contribute to improved HIV viral suppression.

“Providing ‘one-stop shopping’ for HIV and mental health services is ideal, and we hope more Ryan White clinics will seek funding for mental healthcare,” she said.

Some patients saw psychiatrists, others saw psychologists with substance abuse expertise. The study didn’t distinguish between patients who saw one or the other type of expert, and not every patient had the same number of visits. McManus said that some patients saw an increase in viral load suppression with only one session with a mental health professional.

McManus said that there’s not enough evidence to say that mental healthcare itself suppresses HIV viral load. “But we can say there’s an association,” she said.

Speculating on why this would be the case, McManus said that people with chaos in their life may improve their adherence to medication by just having someone to talk to.

“I say anyone can benefit from talking to a counselor,” she said. “But because our clinic is in the south, we see patients suffering from a lot of stigma. Often they’ve told one person, or nobody, about [having HIV].”

The researchers added some caveats: it’s a small, retrospective study, they say, and additional research is needed to determine whether increased access to mental health care can aid viral suppression, and if so, why that might be the case.

Regarding their findings that younger and African American clients didn’t see as much benefit from mental health services, at least regarding viral suppression, McManus said that providers at clinics need to ask the patients what their needs are and what are the ways a clinic could better address them.

The study’s authors were Raina Aggarwal, Michael Pham, Rebecca Dillingham and McManus.


Larry Buhl is a multimedia journalist, screenwriter, and novelist living in Los Angeles. Follow him on Twitter @LarryBuhl.