Does Diagnosis Make a Difference? Estimating the Impact of an HIV Medication Adherence Intervention for Persons with Serious Mental Illness

Abstract

The heightened risk of persons with serious mental illness to contract and transmit human immunodeficiency virus (HIV) is a public health problem. Here we evaluate the interaction between psychiatric diagnosis and response to a community based-intervention targeted at treatment adherence in 236 HIV+ persons with co-occurring mental illness. To examine differential effectiveness of the intervention for categories of patient diagnosis, we reanalyzed the data after stratifying participants into two diagnostic groups: (1) participants with depressive disorders without psychosis and (2) participants with a psychotic or bipolar disorder. Outcomes included viral load and mental health quality of life (SF-12 Mental Health). We found that HIV+ persons with non-psychotic depressive disorders demonstrated a larger decrease in HIV viral load and more improvement in measures of mental health quality of life when compared to HIV+ persons with psychotic and bipolar disorders. We suggest that successful adherence interventions should be informed by psychiatric symptomatology.

Trial registration: clinicaltrials.gov 29 identifier NCT00264823.

Keywords: HIV; PATH+; Psychiatric diagnosis; Root cause analysis; Treatment adherence.

Fig. 1

Growth Curve Models for Simultaneous Analysis of HIV Bio-markers and SF-12 Mental Health Score. Constructed from equations in Table 4

Fig. 2

Growth Curves for Participant Subgroups and Experimental Status