title: Psychiatric correlates of HAART utilization and viral load among HIV-positive impoverished persons.
abstract: OBJECTIVE
  Research on the role psychiatric factors in HIV disease management has yielded discrepant findings, possibly because prior studies did not include comprehensive psychiatric screeners. This study administered a validated screener to examine psychiatric correlates of highly active antiretroviral therapy (HAART) utilization and viral load.
  
  
  METHODS
  Community-recruited, HIV-positive impoverished persons provided sociodemographic information, completed a Diagnostic Interview Schedule that screened for psychiatric disorders, and provided a blood sample to measure HIV disease markers.
  
  
  METHODS
  In this cross-sectional investigation with 227 participants, a multiple logistic regression model examined correlates of HAART utilization compared to a reference group that was eligible for (i.e. CD4(+) cell count <350 cells/μl) but not taking HAART. A multiple linear regression model examined correlates of HIV viral load among 147 participants on HAART.
  
  
  RESULTS
  Sleeping on the street [adjusted OR (AOR) = 0.06; 95% confidence interval (CI) = 0.01–0.26] and screening positive for a stimulant use disorder (AOR = 0.29; 95% CI = 0.13–0.65) were independently associated with lower odds of HAART utilization. Conversely, enrollment in the AIDS Drug Assistance Program (AOR = 3.94; 95% CI = 1.45–10.73) and receipt of mental health treatment (AOR = 4.78; 95% CI = 1.77–12.87) were independently associated with increased odds of HAART utilization. Among those on HAART, screening positive for a severe mental illness was independently associated with a six-fold higher viral load.
  
  
  CONCLUSIONS
  Providing psychiatric treatment could optimize health outcomes among HIV-positive impoverished persons and boost the effectiveness of 'test and treat' approaches to HIV prevention.
authors.affiliation: University of California, San Francisco Center for AIDS Prevention Studies, California, USA. adam.carrico@ucsf.edu
authors.forename: Adam W
authors.initials: AW
authors.lastname: Carrico
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
authors.forename: Maggie
authors.initials: M
authors.lastname: Chartier
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Dilworth
authors.forename: Elise D
authors.initials: ED
authors.lastname: Riley
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012495:San Francisco / Q000453:epidemiology; D019562:Viral Load