Integrating mental health services into primary care for HIV-infected pregnant and non-pregnant women: whole life—a theoretically derived model for clinical care and outcomes assessment

Poor women of color who are disproportionately both infected and affected by HIV/AIDS also face multiple lifestyle and psychosocial burdens that complicate effective delivery of health care, thereby contributing to their poorer prognosis. Addressing these factors within the context of HIV/AIDS primary care for women is the aim of Whole Life, a program to integrate mental health services into primary care for HIV-infected pregnant and non-pregnant women. Whole Life utilizes a theoretically derived clinical services model that provides data for both clinical care and patient outcomes research within the constraints of a clinical setting. During a woman’s first two clinic visits, data are gathered in structured interviews with standardized instruments—adapted for relevance to the population—that meet clinical and service needs, as well as measure components of the Whole Life model. Interviews are conducted by existing front-line staff who have been trained in using these instruments to gather information typically recorded in clinical notes. The implementation of Whole Life to date clearly demonstrates the feasibility of mental health–primary care services integration in a publicly funded HIV primary care clinic serving poor women of color

Integrating mental health services into primary HIV care for women: the Whole Life project.

The high rate of mental health problems in HIV-infected women jeopardizes the health of this vulnerable population, and constitutes a mandate for integrating mental health services into HIV primary care. The Whole Life project-a collaboration of the departments of Psychiatry and Obstetrics/Gynecology at the University of Miami School of Medicine-successfully integrated mental health services into primary HIV care for women. This article describes the conceptual framework of the integration, implementation strategies, effects of the service integration, and lessons learned. Funded by the Health Resources and Services Administration (HRSA) as a Special Program of National Significance (SPNS), Whole Life efforts have been sustained beyond the demonstration funding period as a result of the changes brought about in organizational structures, service delivery, and the providers' conceptualization of health for HIV-infected women

Retention, adherence, and compliance: special needs of HIV-infected adolescent girls and young women

To demonstrate that whereas all HIV-infected youth evidence complex factors that challenge retention in care and adherence to treatment, HIV-infected females have additional issues that are gender-specific. Preliminary data from a subset of 21 adolescent/young women under age 25 from the Whole Life mental health-perinatal HIV care project were analyzed to illustrate the needs of these patients. Of the 21 young women assessed, all but one was of minority background, and a sizeable majority had limited education (<high school diploma) and were quite poor (incomes <$500/mo.). Nearly 67% first learned of their HIV status between ages 16 and 19 years. More than three-fourths were pregnant and, of these, more than one-third entered prenatal care in the last trimester. More than half had responsibility for one to two other children. Two-thirds reported having unprotected sex in the prior 6 months. Nearly 43% had CD4 counts of 500 or below. About one-third screened positive for a mental health problem, and the majority reported a striking frequency of exposure to abusive events and traumatic losses across their short lifetimes. Adolescent girls and young women have unique needs for developmentally appropriate medical and psychosocial approaches to promote retention and adherence