title: Low Rates of HIV Testing Among Adults With Severe Mental Illness Receiving Care in Community Mental Health Settings.
abstract: OBJECTIVE
  This research aimed to characterize HIV testing rates among Medicaid recipients with severe mental illness who received public specialty mental health services.
  
  
  METHODS
  This retrospective cohort study examined California Medicaid records from October 1, 2010, to September 30, 2011 (N=56,895). Study participants were between age 18 and 67, utilized specialty mental health care services, were prescribed antipsychotic medications, and were not dually eligible for Medicare. Adjusted Poisson regression models were used to estimate the overall effects of predictor variables on HIV testing prevalence.
  
  
  RESULTS
  During the study period, 6.7% of people with severe mental illness received HIV testing. Men were 32% less likely to be tested for HIV than women (p<.001). Compared with whites, Asians/Pacific Islanders were 53% less likely and blacks were 82% more likely to be tested (p<.001). Those with comorbid drug or alcohol use disorders were more likely to be tested than those without such disorders (p<.001). Utilization of nonpsychiatric medical care was the strongest predictor of HIV testing (p<.001).
  
  
  CONCLUSIONS
  Most adults with severe mental illness receiving public specialty mental health services were not tested for HIV during a one-year period. Public health administrators must prioritize HIV testing for early identification of HIV infection and prevention of HIV transmission.
authors.affiliation: Dr. Mangurian, Mr. Lee, and Dr. Dilley are with the Department of Psychiatry and the Weill Institute for Neurosciences; Dr. Schillinger is with the Department of Medicine; Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics; Ms. Creasman is with the Clinical and Translational Science Institute (CTSI); and Dr. Fuentes-Afflick is with the Department of Pediatrics, all at the School of Medicine, University of California, San Francisco (UCSF) (e-mail: christina.mangurian@ucsf.edu ). Dr. Mangurian, Dr. Schillinger, Dr. Fuentes-Afflick, and Dr. Dilley are also with Zuckerberg San Francisco General Hospital, San Francisco. Dr. Cournos is with the Department of Psychiatry, Columbia University, New York City. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis.
authors.forename: Christina
authors.initials: C
authors.lastname: Mangurian
authors.affiliation: Dr. Mangurian, Mr. Lee, and Dr. Dilley are with the Department of Psychiatry and the Weill Institute for Neurosciences; Dr. Schillinger is with the Department of Medicine; Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics; Ms. Creasman is with the Clinical and Translational Science Institute (CTSI); and Dr. Fuentes-Afflick is with the Department of Pediatrics, all at the School of Medicine, University of California, San Francisco (UCSF) (e-mail: christina.mangurian@ucsf.edu ). Dr. Mangurian, Dr. Schillinger, Dr. Fuentes-Afflick, and Dr. Dilley are also with Zuckerberg San Francisco General Hospital, San Francisco. Dr. Cournos is with the Department of Psychiatry, Columbia University, New York City. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis.
authors.forename: Francine
authors.initials: F
authors.lastname: Cournos
authors.affiliation: Dr. Mangurian, Mr. Lee, and Dr. Dilley are with the Department of Psychiatry and the Weill Institute for Neurosciences; Dr. Schillinger is with the Department of Medicine; Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics; Ms. Creasman is with the Clinical and Translational Science Institute (CTSI); and Dr. Fuentes-Afflick is with the Department of Pediatrics, all at the School of Medicine, University of California, San Francisco (UCSF) (e-mail: christina.mangurian@ucsf.edu ). Dr. Mangurian, Dr. Schillinger, Dr. Fuentes-Afflick, and Dr. Dilley are also with Zuckerberg San Francisco General Hospital, San Francisco. Dr. Cournos is with the Department of Psychiatry, Columbia University, New York City. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis.
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.affiliation: Dr. Mangurian, Mr. Lee, and Dr. Dilley are with the Department of Psychiatry and the Weill Institute for Neurosciences; Dr. Schillinger is with the Department of Medicine; Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics; Ms. Creasman is with the Clinical and Translational Science Institute (CTSI); and Dr. Fuentes-Afflick is with the Department of Pediatrics, all at the School of Medicine, University of California, San Francisco (UCSF) (e-mail: christina.mangurian@ucsf.edu ). Dr. Mangurian, Dr. Schillinger, Dr. Fuentes-Afflick, and Dr. Dilley are also with Zuckerberg San Francisco General Hospital, San Francisco. Dr. Cournos is with the Department of Psychiatry, Columbia University, New York City. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis.
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.affiliation: Dr. Mangurian, Mr. Lee, and Dr. Dilley are with the Department of Psychiatry and the Weill Institute for Neurosciences; Dr. Schillinger is with the Department of Medicine; Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics; Ms. Creasman is with the Clinical and Translational Science Institute (CTSI); and Dr. Fuentes-Afflick is with the Department of Pediatrics, all at the School of Medicine, University of California, San Francisco (UCSF) (e-mail: christina.mangurian@ucsf.edu ). Dr. Mangurian, Dr. Schillinger, Dr. Fuentes-Afflick, and Dr. Dilley are also with Zuckerberg San Francisco General Hospital, San Francisco. Dr. Cournos is with the Department of Psychiatry, Columbia University, New York City. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Creasman
authors.affiliation: Dr. Mangurian, Mr. Lee, and Dr. Dilley are with the Department of Psychiatry and the Weill Institute for Neurosciences; Dr. Schillinger is with the Department of Medicine; Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics; Ms. Creasman is with the Clinical and Translational Science Institute (CTSI); and Dr. Fuentes-Afflick is with the Department of Pediatrics, all at the School of Medicine, University of California, San Francisco (UCSF) (e-mail: christina.mangurian@ucsf.edu ). Dr. Mangurian, Dr. Schillinger, Dr. Fuentes-Afflick, and Dr. Dilley are also with Zuckerberg San Francisco General Hospital, San Francisco. Dr. Cournos is with the Department of Psychiatry, Columbia University, New York City. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis.
authors.forename: Bernard
authors.initials: B
authors.lastname: Lee
authors.affiliation: Dr. Mangurian, Mr. Lee, and Dr. Dilley are with the Department of Psychiatry and the Weill Institute for Neurosciences; Dr. Schillinger is with the Department of Medicine; Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics; Ms. Creasman is with the Clinical and Translational Science Institute (CTSI); and Dr. Fuentes-Afflick is with the Department of Pediatrics, all at the School of Medicine, University of California, San Francisco (UCSF) (e-mail: christina.mangurian@ucsf.edu ). Dr. Mangurian, Dr. Schillinger, Dr. Fuentes-Afflick, and Dr. Dilley are also with Zuckerberg San Francisco General Hospital, San Francisco. Dr. Cournos is with the Department of Psychiatry, Columbia University, New York City. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis.
authors.forename: Penelope
authors.initials: P
authors.lastname: Knapp
authors.affiliation: Dr. Mangurian, Mr. Lee, and Dr. Dilley are with the Department of Psychiatry and the Weill Institute for Neurosciences; Dr. Schillinger is with the Department of Medicine; Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics; Ms. Creasman is with the Clinical and Translational Science Institute (CTSI); and Dr. Fuentes-Afflick is with the Department of Pediatrics, all at the School of Medicine, University of California, San Francisco (UCSF) (e-mail: christina.mangurian@ucsf.edu ). Dr. Mangurian, Dr. Schillinger, Dr. Fuentes-Afflick, and Dr. Dilley are also with Zuckerberg San Francisco General Hospital, San Francisco. Dr. Cournos is with the Department of Psychiatry, Columbia University, New York City. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis.
authors.forename: Elena
authors.initials: E
authors.lastname: Fuentes-Afflick
authors.affiliation: Dr. Mangurian, Mr. Lee, and Dr. Dilley are with the Department of Psychiatry and the Weill Institute for Neurosciences; Dr. Schillinger is with the Department of Medicine; Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics; Ms. Creasman is with the Clinical and Translational Science Institute (CTSI); and Dr. Fuentes-Afflick is with the Department of Pediatrics, all at the School of Medicine, University of California, San Francisco (UCSF) (e-mail: christina.mangurian@ucsf.edu ). Dr. Mangurian, Dr. Schillinger, Dr. Fuentes-Afflick, and Dr. Dilley are also with Zuckerberg San Francisco General Hospital, San Francisco. Dr. Cournos is with the Department of Psychiatry, Columbia University, New York City. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis.
authors.forename: James W
authors.initials: JW
authors.lastname: Dilley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy; D014481:United States; D055815:Young Adult
keywords: AIDS; Community mental health services; Quality of care; Research/service delivery; Schizophrenia