Use of antipsychotic medications among HIV-infected individuals with schizophrenia Ann Bagchi a, * , Usha Sambamoorthi a , Elizabeth McSpiritt a , Philip Yanos a,b , James Walkup a , Stephen Crystal a a Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, 30 College Avenue, New Brunswick, NJ 08901, USA b UMDNJ-New Jersey Medical School, 183 South Orange Avenue, P.O. Box 1709, Newark, NJ 07101-7897, USA Received 17 March 2003; received in revised form 2 February 2004; accepted 13 February 2004 Available online 27 April 2004 Abstract Persons with schizophrenia face elevated risk of infection with HIV. While HIV therapy is demanding, patients diagnosed with both conditions also require appropriate and consistent management of their psychiatric illness, for the same reasons that generally apply to persons with schizophrenia and because untreated psychiatric illness can interfere with full participation in HIV care. This study examines the correlates of use of and persistence on antipsychotic medications among HIV-infected individuals with schizophrenia, using merged New Jersey HIV/AIDS surveillance data and paid Medicaid claims. Persistence was defined as at least 2 months of medication use in a quarter. We identified 350 individuals who were dually diagnosed with HIV and schizophrenia. Overall, 81% of these beneficiaries had at least one claim for an antipsychotic medication at some point between 1992 and 1998. Multivariate techniques were used, including simple logistic regressions on use and robust longitudinal regressions that controlled for repeated observations on the same individual and treatment gaps. Among users of antipsychotic medications, persistence was very low at 37%. Racial/ethnic minorities were less likely to receive atypical antipsychotic medications. Use of atypical antipsychotics was associated with higher persistence. Our study confirmed past findings of racial disparities in the receipt of atypical antipsychotic medications. Findings suggest that use of atypical medications may benefit individuals dually diagnosed with HIV and serious mental illness. D 2004 Elsevier B.V. All rights reserved. Keywords: Medicaid; AIDS/HIV; Antipsychotic medications; Schizophrenia; Persistence 1. Introduction Previous research among New Jersey Medicaid recipients found that 5.7% of HIV-infected individuals also suffered from schizophrenia (Walkup et al., 1999). Other studies confirm higher rates of serious mental illness among individuals with HIV infection than among the general population (Blank et al., 2002; Kilbourne et al., 2001; Cournos and McKinnon, 1997; Stoskopf et al., 2001), with a concomitant increase in the burden of care and treatment for HIV/AIDS. A number of studies document the significance of man- aging the symptoms of mental disorders as a means of 0920-9964/$ - see front matter D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2004.02.021 * Corresponding author. Tel.: +1-732-932-6949; fax: +1-732- 932-8592. E-mail address: abagchi@ihhcpar.rutgers.edu (A. Bagchi). www.elsevier.com/locate/schres Schizophrenia Research 71 (2004) 435 – 444