title: Utilization of mental health and substance abuse care for people living with HIV/AIDS, chronic mental illness, and substance abuse disorders.
abstract: OBJECTIVE
  To examine the effects of race/ethnicity, insurance, and type of substance abuse (SA) diagnosis on utilization of mental health (MH) and SA services among triply diagnosed adults with HIV/AIDS and co-occurring mental illness (MI) and SA disorders.
  
  
  METHODS
  Baseline (2000 to 2002) data from the HIV/AIDS Treatment Adherence, Health Outcomes, and Cost Study.
  
  
  METHODS
  A multiyear cooperative agreement with 8 study sites in the United States. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was administered by trained interviewers to determine whether or not adults with HIV/AIDS had co-occurring MI and SA disorders.
  
  
  METHODS
  Subjects were interviewed in person about their personal characteristics and utilization of MH and SA services in the prior 3 months. Data on HIV viral load were abstracted from their medical records.
  
  
  RESULTS
  Only 33% of study participants received concurrent treatment for MI and SA, despite meeting diagnostic criteria for both: 26% received only MH services, 15% received only SA services, and 26% received no services. In multinomial logistic analysis, concurrent utilization of MH and SA services was significantly lower among nonwhite and Hispanic participants as a group and among those who were not dependent on drugs and alcohol. Concurrent utilization was significantly higher for people with Veterans Affairs Civilian Health and Medical Program of the Uniformed Services (VA CHAMPUS) insurance coverage. Two-part models were estimated for MH outpatient visits and 3 SA services: (1) outpatient, (2) residential, and (3) self-help groups. Binary logistic regression was estimated for any use of psychiatric drugs. Nonwhites and Hispanics as a group were less likely to use 3 of the 5 services; they were more likely to attend SA self-help groups. Participants with insurance were significantly more likely to receive psychiatric medications and residential SA treatment. Those with Medicaid were more likely to receive MH outpatient services. Participants who were alcohol dependent but not drug dependent were significantly less likely to receive SA services than those with dual alcohol and drug dependence.
  
  
  CONCLUSIONS
  Among adults with HIV/AIDS and co-occurring MH and SA disorders, utilization of MH and SA services needs to be improved.
authors.affiliation: Department of Health Services, University of Washington, Seattle, WA, USA. mweaver@u.washington.edu
authors.forename: Marcia R
authors.initials: MR
authors.lastname: Weaver
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Conover
authors.forename: Rae Jean
authors.initials: RJ
authors.lastname: Proescholdbell
authors.forename: Peter S
authors.initials: PS
authors.lastname: Arno
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ang
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007341:Insurance / Q000706:statistics & numerical data; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D008962:Models, Theoretical; D012959:Socioeconomic Factors; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014481:United States; D044465:White People / Q000706:statistics & numerical data