Exploring Integrated Treatment for HIV/AIDS in Individuals with Co-occurring Disorders

1. Breakout 8: HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study AHSR 2005 Annual Conference Jerry Flanzer, Moderator

2. Section A Brief Overview of the “Cost Study”: Status and Untapped Potential Jerry Flanzer, NIDA Ali Manwar, CSAT James Bell, James Bell Associates

3. Ground Breaking The first United States Federal effort to focus on people living with HIV/AIDS who also have a diagnosed mental health and substance use disorder.

4. Six Collaborating Federal Agencies • NIH-National Institute on Drug Abuse • NIH-National Institute on Alcohol Abuse and Alcoholism • NIMH-National Institute of Mental Health • SAMHSA-Center for Mental Health Services • SAMHSA-Center for Substance Abuse Treatment • HRSA-HIV/AIDS Bureau

5. Principal Investigators and Sites • Marcia Andersen, Well-Being Institute, Detroit, MI; • Robert Calsyn, University of Missouri, St. Louis, MO; • Terence Keane, Boston University School of Medicine, Boston, MA; • Stanley Sacks, National Development & Research Institutes, Inc., Philadelphia, PA; • Tomas Soto, Cook County Bureau of Health Services/CORE Center, Chicago, IL; • Karina Uldall, University of Washington, Seattle, WA; • Mark Winiarski, Montefiore Medical Center, Bronx, NY; • Kathryn Whetten, Duke University, Durham, NC; • James Bell, Coordinating Center, James Bell Associates, Arlington, VA.

6. Cost Study Overview • A multi-site cooperative research program to investigate integrated treatment interventions for persons living with HIV and co-occurring mental and substance use disorders. • Tested heterogeneous models of integrated care suited to local delivery system features and Site preferences for intervention approach (seven RCTs). • Research interview data was collected on clinical diagnosis, symptom severity, medication adherence, demographics, socio-economic characteristics, and service utilization at baseline, 3-, 6-, 9- and 12-month intervals for a convenience sample of 1138 cases (all Sites). - The Client Assessment Data Base will be made available for public use; as will an Intervention Service Record (ISR) Data Base that is linked with the Client Assessment Data Base through a unique case identifier.

7. Selected Client Assessment Instruments

8. Descriptions Of Selected Interventions*

9. Description Of Selected Interventions, continued

10. Mental Health Diagnoses Axis I and Axis II

11. Alcohol & Drug Use Disorders

12. Study Status and Next Steps – Focus on highly vulnerable disadvantaged population. – Broad and deep data that meets high standards for measurement quality. – Convenience sample of 1138 cases split between experimental integrated treatment interventions and care-as-usual controls at eight Sites. – Most important findings on outcomes are undetermined, as yet. – Seminal papers have or will address, individually and collectively, topics, such as the following: effects of integrated treatment interventions on HIV and psychiatric medication adherence, physical health status, mental health status, and substance abuse status; correlates of entry and retention in integrated and standard medical and behavioral health care; and health care services utilization and cost. – Untapped potential to inform a much needed new paradigm of care for persons living with HIV and complex co-occurring disorders (the shift to chronic disease management). • The HIV/AIDS Cost Study Data Bases should be available for public use within 12 months. To find out more about these data, and currently planned publications, please contact James Bell (bell@jbassoc.com) or Cheryl McDonnell (mcdonnell@jbassoc.com).