Substance Use and Mental Health Comorbidities and Receipt of Specialty Care Among Patients Enrolled in a Low-Barrier HIV Clinic

Abstract

Low-barrier care is one model of a differentiated service delivery approach for people with HIV (PWH) who are not engaged in conventionally-organized HIV care. Although psychiatric and substance use disorders are common among patients in low-barrier clinics, approaches to behavioral health service delivery within this context have not been well-described. We conducted a descriptive analysis using retrospective review of medical records to evaluate substance use and psychiatric comorbidities and receipt of behavioral health services among patients in the Max Clinic in Seattle, Washington. Among 227 patients enrolled from 2015 to mid-2020, most had a history of hazardous substance use (85%), a psychiatric diagnosis (69%) or unstable housing (69%) documented in the medical record. Less than half of patients referred for depression treatment (33%) or for opioid use disorder treatment (40%) completed even one specialty care visit. More effective approaches are needed to engage patients in behavioral health services within the context of low-barrier HIV care.

Keywords: HIV; Housing Instability; Mental Disorders; Population Characteristics; Substance-Related Disorders.

Fig. 1. Overlap of substance use, psychiatric diagnoses and unstable housing among Max Clinic patients enrolled 2015-19 (N=227)

Note: Size of the circles is not to scale * 6 people do not fit into any circle ^a Includes those using at least one of the following at baseline: Methamphetamine, heroin, cocaine/crack cocaine, hazardous alcohol use, marijuana, prescription-type opioids, prescription-type benzodiazepines ^b Includes those diagnosed with at least one of the following at baseline: Depressive d/o, bipolar and related d/o, anxiety d/o, trauma and stressor-related d/o, PTSD, schizophrenia spectrum and other psychotic disorders, neurodevelopmental disorders, ADD, personality disorders, feeding and eating disorders. ^c Includes those sleeping outside, staying in a shelter, in transitional housing, or unstable housing (couch-surfing etc.)