This proposed administrative supplement will take advantage of the extended study follow-up to examine the relationship of changes in substance use over time to both mental health outcomes and HIV clinical outcomes, and will also examine predictors of suicidal ideation among people with HIV (PWH). Substance use disorders (SUDs) and depression are common among PWH and lead to poor HIV treatment outcomes and increased mortality. To enhance HIV care, the parent study examines the impact of self-administered computerized screening for SUD risk and depression using validated measures. Screening is conducted every six months, with results integrated into the electronic health record (EHR) and available for use by the multidisciplinary HIV care team, including physicians and behavioral health specialists. Screening uses validated measures (Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS); and Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-2) delivered via secure messaging and on tablets in waiting rooms. We extended follow-up for clinic sites with a current total of 3,510 completed questionnaires to date, including 2,291 online and 1,200 tablet completions. We anticipate completing a total of 3,600 completions, including 750 patients with multiple screenings, resulting in a robust longitudinal dataset of SUD risk scores and mental health symptoms over time, which we will link to HIV clinical outcomes (HIV viral control and CD4 cell counts) recorded in the electronic health record. The proposed administrative supplement has three aims supporting analyses involving the data from extended follow-up: 1) To evaluate clinical factors associated with longitudinal changes in self-reported substance use and mental health symptoms. 2) To evaluate the relationship of changes in drug and alcohol use over time with HIV clinical outcomes. 3) To identify social, behavioral and clinical risk factors for suicidal ideation to inform ongoing care for high-risk patients. Together, the objectives of the proposed supplement would enhance our ability to address the specific aims of the original grant, by extending study findings to longer- term substance use, mental health, and HIV outcomes and broaden the focus to include the relationship of substance use and treatment to psychiatric symptoms including suicidal ideation.
Substance use, psychiatric symptoms and suicidal ideation are significant comorbidities among people living with HIV. Few studies have examined suicidal ideation in persons with HIV and the extent to which changes in drug and alcohol use are associated with changes in mental health symptoms and improvements in HIV outcomes. Our proposed study examines these important public health questions.
