Health Services Used by HIV/AIDS Patients - Essay Example

Your Section December 3, Your email Address Living with a disease like HIV/AIDS is not easy. Not only can HIV/AIDS create psychological illnesses in others, but also, often people diagnosed with HIV/AIDS have co-morbid psychiatric conditions along with substance abuse disorder. There is not enough data present about the health services used by HIV/AIDS patients with mental illnesses and/or substance abuse disorder. The advances in medicine in the 90s, and the anti-HIV combination therapies made it possible for people with HIV/AIDS to live longer, thereby making chronic condition care a burdensome issue not only for the patient but for the service providers. This not only includes economic factors, but also the fact that effective treatment demands that the medication regimens that consist of multiple drugs are adhered to as strictly as possible. Even a singly lapse thereof can jeopardize the success of the therapy by causing treatment resistance that causes entire classes of drugs to become impotent or by the development of treatment-resistant strains of HIV. Following such a regime is hard on its own, but for those who have substance abuse and/or mental illnesses and who have many stressors it is harder still. Therefore, it is a necessity that HIV/AIDS patients with such accumulative issues be given more help as they are, otherwise, highly likely to not get effective medication. A need for integrated care approaches was found, because the traditional approach was not a success; (both sequential and parallel) this included treatment in one system before entering another and independent treatments in multiple delivery systems. What is more, it was observed that the burden of co-ordinating unintegrated services was placed on the patients rather than on providers. The HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study (HIV/AIDS Cost Study) was a study that aimed to explore the possibility of integrated interventions for HIV primary care, mental health, and substance abuse and find out its cost effectiveness as well. Specifically, the study addressed the following issues: 1. The need to have integrated services for people who are triply diagnosed (with HIV, substance abuse disorder and mental illness). 2. The need to demonstrate that such services would produce better health outcomes than the traditional methods, and 3. The need to establish the cost-effectiveness of the program. This was done so that a set of best practices could be established to treat triply diagnosed patients. Previously integrated approaches for treatment of substance abuse and mental health were quite promising1; however, they involved patients who were not HIV-infected, therefore, this approach needed to be specifically tested for HIV/AIDS patients who also suffered from mental illness and substance abuse disorder. As little was known about how integrated treatment works with HIV-infected patients, this study was an attempt to not only see its efficacy but also to remove barriers so as to make it easier for people to access comprehensive HIV primary care, mental health and substance use services as people with HIV and co-morbid conditions were deemed to be at high risk for poor health outcomes. The HIV Cost Study targeted two overlapping populations: 1. HIV-infected with substance abuse disorders along with co-morbid mental illnesses. 2. HIV-infected with serious mental illnesses. Priority population for the HIV Cost Study were those who were HIV positive, were 16 years or older, had had substance abuse disorder diagnosed in the past 12 months, and diagnosable mental health disorder which persisted long enough for a mental care giver to diagnose it during the preceding 12 months. Moreover, other instruments were also used to determine the eligibility for the program. Table 1 describes them: Table 1. Core Assessment Instruments Included in the HIV Integrated Treatments Study. At each of the 8 sites of the HIV Cost Study the outcomes of the new integrated intervention were compared against those of the traditional methods, and most of the study participants were assigned randomly to either of the two groups. The integrated HIV services included having 1. Co-located HIV/AIDS, mental health and substance abuse medical care, that is to say placing these three services in the same location, and 2. Interagency co-ordination which entailed care givers to integrate their services when the primary care, mental health, and substance abuse service agencies were physically separated. The HIV Cost Study also involved consumers by keeping consumer advisory boards involved and informed. The eight sites of the HIV Cost Study were varied along two parameters. 1. The first factor that caused variability was whether the service system capacity that existed at the start of the Study was sufficient or not. Some of the sites were lacking in anything more than baseline services when it came to substance abuse and mental health issues. These sites were used to test different models for co-ordinating and integrating these three services. 2. The second cause of variability was the difference in ability of these sites to address the needs of the triply diagnosed clients with regard to the stage of the treatment. This meant that the different sites of the Study could involve triply diagnosed clients at different stages of their treatment, for instance at one end were street outreach programs done by the sites that tried to reach clients that did not visit the clinics themselves, whereas on the other end were the high end models available to clients, whereby residential treatment was meted out to clients that included aftercare as well, which entailed continued therapy and care management. The study found that when integrated treatment was given (especially for 18 months or longer), there was significant reduction in substance abuse and hospital use and a significant increase in remission and health outcomes. However, it also found out that there was still much more need for research into integrated care giving to determine various factors thereto including the capacity of service delivery systems to address other needs of multiply diagnosed HIV/AIDS clients, as well as to examine how multiple diagnoses are managed by these integrated services. Read More