HIV patients with mental illness can benefit from APRN care management

In a four-year study, researchers at the University of Pennsylvania have found that assigning adults with serious mental health illness who are HIV positive to the care of advanced practice nurses (APRN) to help navigate the health care system and maintain adherence to drug regimens reduced depression and improved their overall physical health, indicating that healthcare policy should be revamped to provide this support.

"Implementation of community-based nurse management using APRNs for complex patient populations may improve long-term outcomes and reduce the high costs of care. This study suggests that APRN care management should be a central component of the redesign of health care delivery to this vulnerable population," said Penn Nursing professor Nancy P. Hanrahan, PhD, RN, the lead author of the study which appeared in Nursing Research and Practice. Members of Penn Medicine also participated in the study.

Adults with serious mental illnesses die, on average, 25 years earlier than the rest of the population. Because of their illness, these adults often live in poverty or in disadvantaged neighborhoods and are more likely to abuse controlled substances and suffer cognitive impairment. This convergence of factors often makes it difficult for these adults to navigate the complex requirements of today's healthcare system, which can in turn cause their health to spiral downward.

Those adults with serious mental illness such as schizophrenia and bipolar disorder can also then engage in risky behaviors such as casual sexual relationships or intravenous drug use that infect them with HIV. Continued risky behavior, sometimes fueled by a lack of adherence to prescribed medications for their mental health condition, promotes the spread of the virus.