Screening Tool for Mental Illness, Substance Abuse Validated
Pence, et al conducted a validation study of the Substance Abuse and Mental Illness Symptoms Screener (SAMISS), a 16-item screening instrument designed to identify substance abuse and mental illness in HIV-infected patients. The Structured Clinical Interview for DSM-IV (SCID) was used as the reference to evaluate the performance of the SAMISS in this study. The study population was comprised of HIV-infected patients who had never previously been screened with the SAMISS. Of 148 participants who completed follow-up, 37.2% screened positive on the SAMISS substance abuse (SA) module. Compared with the SCID, the SA module of the SAMISS had 86% sensitivity and 75% specificity. Of 143 participants who completed SCIDs and complete data information, 69.2% screened positive on the mental illness (MI) module of the SAMISS. Compared with the SCID, the MI module of the SAMISS had 95% sensitivity and 49% specificity. Study authors concluded that the SAMISS demonstrated high sensitivity and moderate specificity as a screening tool for the identification of SA/MI in this HIV-infected patient population. The brevity of the SAMISS makes it practical for routine use in busy clinical settings, but should be followed by a more rigorous psychiatric evaluation for patients who screen positive.
Pence B, Gaynes B, Whetten K, et al. Validation of a brief screening instrument for substance abuse and mental illness in HIV-positive patients. J Acquir Immune Defic Syndr. 2005; 40(4):434-44.
Clinician-Delivered Intervention to HIV Patients Reduces Risk Behaviors
Fisher, et al conducted a prospective clinical trial to evaluate the effectiveness of a clinician-delivered intervention in reducing unprotected sexual behavior of HIV-infected patients. The risk reduction intervention consisted of brief, patient-centered discussions, conducted during routine clinical visits, over a study interval of 18 months. During these discussions, clinician and patient negotiated an individually tailored behavior change, goal or plan. Sessions concluded with the patient being given a "prevention prescription" written on a prescription pad. Analysis of the intervention demonstrated that unprotected vaginal, anal and insertive oral sexual events decreased significantly over time among HIV-infected patients who received the clinician-delivered HIV prevention intervention. By contrast, the same measures increased significantly over time for HIV-infected patients in the standard-of-care control arm. Study authors concluded that a clinician-delivered HIV prevention intervention, implemented during the course of routine clinical care, can be effective in reducing a broad measure of HIV-infected patients' unprotected vaginal, anal and insertive oral sexual behavior.
Fisher J, Fisher W, Cornman D, et al. Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients. J Acquir Immune Defic Syndr. 2006; 41(1):44-52.
Hospitalizations, Expenditures Due to HCV on the Rise
As the population of patients infected with hepatitis C virus (HCV) grows older, the treatment burden of HCV continues to grow. Grant, et al sought to provide longitudinal statistics concerning health care resource use by HCV-infected patients. Hospitalization trends using the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) were examined. From 1994 through 2001, HCV-related hospitalizations, hospital days, total charges and deaths increased at average annual rates exceeding 20%, more than three-fold higher than rates for all-cause hospitalizations. HCV liver causes for all ages accounted for almost four times as many hospital days in 2001 as in 1994. Increasing hospitalizations and hospital days coincided with higher expenditures for HCV. Study authors concluded that the future burden of HCV infection will match and may exceed analysts' forecasts.
Grant W, Jhaveri R, McHutchinson J, et al. Trends in health care resource use for hepatitis C virus infection in the United States. Hepatology. 2005; 42(6):1406-13.
Antidepressant Treatment Improves Adherence to ART
Untreated depression has been associated with medication non-adherence. To evaluate the effect of anti-depressant treatment (ADT) on antiretroviral (ART) adherence, Yun, et al., retrieved data from chart review for 1,713 HIV-infected patients seen at an urban health care setting. Of these patients, 57% were depressed and of these, 46% and 52% received ADT and ART treatment, respectively. Adherence to ART treatment was lower among depressed patients not adherent to ADT compared to depressed patients adherent to ADT. Study authors concluded that there may be a benefit of ADT on ART adherence among depressed HIV-infected patients.
Yun L, Mavari M, Kobayashi J, et al. Antidepressant Treatment Improves Adherence to Antiretroviral Therapy Among Depressed HIV-Infected Patients. JAIDS. 2005; 38(4):432-8.