Using Medicaid data to advance care for people with schizophrenia at risk for HIV (Medicaid-DASH)

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ABSTRACT This R01 application will provide support for Christina Mangurian, MD, MAS, a psychiatrist at the University of California, San Francisco (UCSF), to conduct research to examine HIV care received by Medicaid recipients with schizophrenia throughout the U.S. Dr. Mangurian has assembled a multidisciplinary team at UCSF, Rutgers University, and Columbia University to facilitate this research. At UCSF, her Co-Investigators include James Dilley, MD, Vice Chair of UCSF Department of Psychiatry; Eric Vittinghoff, Professor of Biostatistics and Epidemiology; Emily Arnold, PhD, Associate Professor, Department of Medicine based at the Center for AIDS Prevention Studies (CAPS); and Kim Koester, PhD, Director of Qualitative Research at CAPS. At Rutgers University, Co-Investigators include Stephen Crystal, PhD, Chair of the Division on Aging and Director of the Center for Education and Research on Mental Health Therapeutics; and James Walkup, PhD, Chair of the Department of Clinical Psychology. Dr. Mangurian also has three consultants: Francine Cournos, MD, Professor of Psychiatry, Columbia University; Mark Olfson, MD, Professor of Psychiatry, Columbia University; and Grant Colfax, MD, Chief of Marin County's Health & Human Services and former Director of the Office of National AIDS Policy. Over 9 million US adults have severe mental illnesses like schizophrenia and bipolar disorder. These people die, on average, 25 years earlier than the general population. Although the most common cause of death is cardiovascular disease, a recent meta-analysis found that people with severe mental illness are up to 10 times more likely than the general population to have HIV. Despite this risk, a systematic review found that HIV testing rates among people with severe mental illnesses such as schizophrenia are quite low. Additionally, the quality of HIV care is poorly understood for people with severe mental illness. This study aims to fill this gap by becoming the largest to examine the HIV continuum of care among people with schizophrenia. There is an urgent need to understand HIV care along the continuum received by people with schizophrenia served in the public healthcare system. In Aim 1, Dr. Mangurian proposes to examine HIV testing of Medicaid recipients with schizophrenia. In Aim 2, she will examine HIV care along the continuum for Medicaid recipients with schizophrenia. In Aim 3, she will identify key strategies used by high performing states. This study will meaningfully contribute to the current understanding of problems along the HIV care continuum for people with schizophrenia. By identifying specific individual-, organizational-, community-, and policy- targets, this study will inform future interventions to close the HIV care continuum gap for people with schizophrenia. If these interventions are effective, this study will be a first step towards improving the HIV care received by people with severe mental illness. As treatment is increasingly understood and accepted as prevention, this work also has public health implications for reducing HIV transmission.