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Stephen Crystal Receives NIH Subaward for Using Medicaid Data to Advance Care for People with Schizophrenia at Risk for HIV (Medicaid-DASH)

Utilizing a national retrospective longitudinal Medicaid cohort (including dual eligible beneficiaries), the research team proposes examination of HIV care among people with schizophrenia served within the US public health care system (N=2,221,168). The cohort is limited to persons with schizophrenia because the validity of claims-based measurement of severe mental illness is most strongly established for this disorder. This study will be the largest cohort study to date examining the HIV care continuum among people with schizophrenia—the most debilitating of severe mental illnesses. A partnership among faculty at UCSF, Columbia University, and Rutgers University will be leveraged to answer key questions about HIV care received by this vulnerable population. In addition to characterizing HIV testing and management of HIV among populations with schizophrenia, individual-, organizational-, community- and policy-level factors will be analyzed for their effect on the use of HIV services.

Over 9 million US adults have severe mental illnesses such as 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 10 times more likely to have HIV than the general population (6% vs 0.5%). Despite this risk, a systematic review found that HIV testing rates among people with severe mental illness are quite low, with work in California finding the annual HIV testing rate to be only 7%. Additionally, studies examining HIV care received by people with severe mental illness who are living with HIV have been limited by small sample sizes, minimal geographic diversity, and reliance on self-report. By identifying specific individual-, organizational-, community-, and policy-level targets, this study will inform future interventions to close the HIV care continuum gap and improve 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.




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