A model of integrated primary care for HIV-positive patients with underlying substance use and mental illness N. ZALLER, F. S. GILLANI, & J. D. RICH The Miriam Hospital, Immunology, Providence, US Abstract There is a high burden of underlying substance use and mental illness in HIV-infected populations. HIV-care settings provide an important opportunity to assess substance-use and mental health needs among HIV-positive patients and to provide or make referrals for appropriate treatment services. In 2003, with funding from the Center for Substance Abuse Treatment (CSAT), we developed a model of integrated substance-use counselling and referral for treatment within a primary care HIV-care setting at The Miriam Hospital in Providence, Rhode Island. The project uses a multidisciplinary approach to provide linkage to treatment services for substance use and mental illness as well as to help participants with social service needs, such as housing and medical coverage, to ensure continuity of care and optimal HIV treatment adherence. Twelve percent of the 965HIV-infected patients in care at our center have been enroled in the project. Of these, all have a current substance-use disorder and 79.3% have been diagnosed with a mental illness. In addition, most participants are hepatitis C-positive (HCV) (65.5%). The majority of participants are on antiretroviral therapy (76.7%). Participants have been referred for the following treatment modalities: intensive outpatient services, methadone, buprenorphine, outpatient services and residential as well as individual and group counselling. Our model has been successful in assessing the substance-use and mental health needs of HIV-infected individuals with numerous co-morbidities and referring them for ancillary medical and social services. Introduction Mental health and substance-use disorders are com- mon among individuals infected with HIV and often interfere with adherence to HIV treatment regimens (Batki, 1990; Tucker et al., 2003). Triply diagnosed patients with HIV, substance use and mental health disorders pose significant challenges to healthcare providers in how to provide appropriate models of integrated care (Douaihy et al., 2003). A recent study found that among adults receiving HIV care in the US, more than half also presented with a psychiatric illness and 42% reported illicit substance use (Bing et al., 2001). Co-morbid psychiatric disorders de- crease quality of life among HIV-positive individuals and decrease normal functioning, which can ad- versely affect HIV treatment (McGowen et al., 2004). Additionally, drug use in particular has been shown to be a barrier to antiretroviral treatment (ART) among persons with HIV (Sherbourne et al., 2000). Individuals with HIV who continue to engage in high-risk behaviors, such as unprotected sex and injection drug use, pose a significant risk of HIV transmission to those who have contact with them in the community (Turner et al., 2001). On-site service delivery can link drug use treat- ment clients to ancillary services (Friedman et al., 2000). Case management appears to be a critical component in not only HIV treatment adherence but also for supportive and ancillary services for HIV- infected individuals (Katz et al., 2000). One recent study found a positive relationship between receipt of ancillary services and access to primary medical care (Chan et al., 2002). Other studies have found significant associations between receipt of ancillary services such as case management, drug and mental health treatment/counselling and complementary services, housing and regular primary care (Ashman et al., 2002; Lo et al., 2002). This demonstrates the need for a multidisciplinary team, consisting of physicians, nurses, counsellors, case managers and social workers, to integrate care for HIV-infected individuals to achieve better treatment outcomes not only for HIV infection but also for co-morbid mental illness and substance use. Multidisciplinary provider collaborations allow for the synthesis of expertise and resources to solve complex problems resulting among triply diagnosed individuals (Soto et al., 2004). Correspondence: Dr. N. Zaller, Ph.D., The Miriam Hospital, Department of Immunology, 164 Summit Avenue, Providence, 02906, US. E-mail: nzaller@lifespan.org AIDS Care, October 2007; 19(9): 11281133 ISSN 0954-0121 print/ISSN 1360-0451 online # 2007 Taylor & Francis DOI: 10.1080/09540120701335196