Mapping psychosocial vulnerabilities to improve HIV and substance use outcomes

Photo credit: VLADGRIN

Psychosocial profiles identified in patients with HIV who use substances may improve outcomes for both conditions through tailored interventions.

“This research was driven by concerns about the high rates of uncontrolled HIV infection and mortality among people living with HIV who use substances that may also be associated with co-occurring psychological symptoms,” shares Renae Schmidt, MPH Doctors Week. “Despite the availability of advanced HIV treatments, this population continues to experience disproportionately poor health outcomes.”

For a study published in AIDS and behaviorAccording to Schmidt, she and her colleagues wanted to “identify and understand the psychosocial factors that may contribute to uncontrolled HIV infection and increased mortality among people with HIV who use substances.”

Specifically, they sought to understand the different psychosocial profiles within this population that may impact health outcomes, “with the ultimate goal of enabling targeted interventions to reduce the risk of uncontrolled infections and mortality in this vulnerable group,” notes Schmidt .

Effects of the basic psychosocial symptoms

The analysis used data from 801 people living with HIV who also use substances (mean age 44.2; 67.4% men; 72.0% black). An estimated 22.0% of patients had a documented psychiatric history and 37.2% were in unstable housing.

According to the study results, the latent class analysis conducted by the researchers revealed five “classes” of individuals “with unique basic psychosocial symptoms.” The courses covered varying levels of mental health symptoms (MHS):

• Class 1: Severe MHS (12.9%)
• Class 2: Moderate MHS with suicidality and no support (16.0%)
• Class 3: Moderate MHS (21.6%)
• Class 4: Mild MHS without support (20.5%)
• Class 5: Minimal MHS (29.1%)

“One of the most important findings is the identification of psychosocial profiles that are associated with a higher risk of uncontrolled HIV infection and mortality,” notes Schmidt. “For example, it was found that individuals with high levels of suicidality, depressive and anxiety symptoms, and reported trauma who also had the highest substance use were at the highest risk of death. Clinicians should be aware of these profiles because patients who match them may benefit from more intensive and tailored interventions, including improved mental health support, substance use treatment, and trauma coping strategies.”

Tailored interventions for specific psychosocial profiles

The extent to which social support influenced health outcomes surprised Schmidt and colleagues.

“The strong influence of social dynamics – such as concrete support from peers and family members with household chores, medication procurement and transportation – underscores the importance of considering these psychosocial factors in addition to clinical care,” she says. “This finding suggests that interventions to improve social support may be as important as those to combat substance use.”

Based on the study results, physicians treating patients with HIV and substance use may “consider a more holistic approach that addresses not only the medical treatment of HIV and substance use, but also the psychosocial symptoms of these individuals.”

Tailored interventions that address the specific psychosocial profiles identified in the study could lead to better health outcomes, Schmidt continues (figure).

“For example, integrating mental health services, improving social support systems, and implementing stigma reduction strategies in HIV treatment could be key components of a successful treatment plan. This research highlights the critical importance of assessing and treating increased mental health symptoms during use to identify those at highest risk of adverse outcomes.”

Future research should aim to develop and test interventions tailored to the psychosocial profiles identified in the study.

“In addition, longitudinal studies are needed to understand how changes in psychosocial factors over time affect HIV outcomes,” explains Schmidt. “Research should also examine the effectiveness of integrating psychosocial interventions into standard HIV care and how these interventions can be expanded to reach a broader population of people living with HIV who use substances.”