title: Access to HAART and utilization of inpatient medical hospital services among HIV-infected patients with co-occurring serious mental illness and injection drug use.
abstract: OBJECTIVE
  Among HIV-infected individuals, we examined whether having co-occurring serious mental illness (SMI) and injection drug use (IDU) impacts: (a) receipt of highly active antiretroviral therapy (HAART), and (b) utilization of inpatient HIV services, compared to those who have SMI only, IDU only or neither SMI nor IDU.
  
  
  METHODS
  Demographic, clinical and resource utilization data were collected from medical records of 5119 patients in HIV primary care at four US HIV care sites in different geographic regions with on-site mental health services in 2001. We analyzed receipt of HAART using multivariate logistic regression and the number of medical hospital admissions using multivariate logistic and Poisson regression analyses, which controlled for demographic factors, receipt of HAART, CD4 count and HIV-1 RNA.
  
  
  RESULTS
  Those with co-occurring SMI and IDU [adjusted odds ratio (AOR)=0.52; 95% confidence interval (95% CI)=0.41-0.81] and those with IDU alone (AOR=0.64; 95% CI=0.58-0.85) were significantly less likely to receive HAART than those with neither SMI nor IDU, controlling for demographic and clinical factors. Those with co-occurring SMI and IDU were more likely to use any inpatient medical services (AOR=2.22; 95% CI=1.64-3.01) and were significantly more likely to use them more frequently (incidence rate ratio=1.33; 95% CI=1.13-1.55) than those with neither SMI nor IDU, SMI only or IDU only.
  
  
  CONCLUSIONS
  HIV-infected individuals with co-occurring SMI and IDU are significantly more likely to utilize HIV-related medical inpatient services than individuals with no comorbidity or with only one comorbidity. Individuals with both SMI and IDU did not differ from those with IDU only in receipt of HAART. Inpatient hospitalizations are expensive, and efforts should be targeted towards these populations to reduce potentially avoidable inpatient care.
authors.affiliation: Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21212, USA. shimelho@psych.umaryland.edu
authors.forename: Seth
authors.initials: S
authors.lastname: Himelhoch
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Chander
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.forename: James
authors.initials: J
authors.lastname: Hellinger
authors.forename: Paul
authors.initials: P
authors.lastname: Gaist
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Gebo
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000534:rehabilitation*; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000628:therapy*