Interventions and approaches to integrating HIV and mental health services a systematic review

• Published in: Health policy and planning Vol. 32; no. suppl_4; pp. iv27 - iv47
• Main Authors: Chuah, Fiona Leh Hoon, Haldane, Victoria Elizabeth, Cervero-Liceras, Francisco, Ong, Suan Ee, Sigfrid, Louise A, Murphy, Georgina, Watt, Nicola, Balabanova, Dina, Hogarth, Sue, Maimaris, Will, Otero, Laura, Buse, Kent, McKee, Martin, Piot, Peter, Perel, Pablo, Legido-Quigley, Helena
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.11.2017; Oxford Publishing Limited (England)
• Subjects: Acquired immune deficiency syndrome; AIDS; Bias; Case management; Case Managers; Clinical outcomes; Comorbidity; Coordination; Cost analysis; Delivery of Health Care, Integrated - methods; Delivery of Health Care, Integrated - organization & administration; Developed Countries; Evaluation; Extraction; Health care expenditures; Health problems; Health services; HIV; HIV Infections - therapy; Human immunodeficiency virus; Humans; Infectious diseases; Integrated care; Integrated delivery systems; Integration; Intervention; Literature reviews; Low income groups; Managers; Medical treatment; Mental disorders; Mental health; Mental health care; Mental health services; Mental Health Services - organization & administration; Patients; REVIEWS; Risk assessment; Systematic review; HIV; integration; mental health
• ISSN: 0268-1080; 1460-2237; 1460-2237
• DOI: 10.1093/heapol/czw169

Abstract Background The frequency in which HIV and AIDS and mental health problems co-exist, and the complex bi-directional relationship between them, highlights the need for effective care models combining services for HIV and mental health. Here, we present a systematic review that synthesizes the literature on interventions and approaches integrating these services. Methods This review was part of a larger systematic review on integration of services for HIV and non-communicable diseases. Eligible studies included those that described or evaluated an intervention or approach aimed at integrating HIV and mental health care. We searched multiple databases from inception until October 2015, independently screened articles identified for inclusion, conducted data extraction, and assessed evaluative papers for risk of bias. Results Forty-five articles were eligible for this review. We identified three models of integration at the meso and micro levels: single-facility integration, multi-facility integration, and integrated care coordinated by a non-physician case manager. Single-site integration enhances multidisciplinary coordination and reduces access barriers for patients. However, the practicality and cost-effectiveness of providing a full continuum of specialized care on-site for patients with complex needs is arguable. Integration based on a collaborative network of specialized agencies may serve those with multiple co-morbidities but fragmented and poorly coordinated care can pose barriers. Integrated care coordinated by a single case manager can enable continuity of care for patients but requires appropriate training and support for case managers. Involving patients as key actors in facilitating integration within their own treatment plan is a promising approach. Conclusion This review identified much diversity in integration models combining HIV and mental health services, which are shown to have potential in yielding positive patient and service delivery outcomes when implemented within appropriate contexts. Our review revealed a lack of research in low- and middle- income countries, and was limited to most studies being descriptive. Overall, studies that seek to evaluate and compare integration models in terms of long-term outcomes and cost-effectiveness are needed, particularly at the health system level and in regions with high HIV and AIDS burden.