HIV This Week

Husbands W, Browne G, Caswell J, Buck K, Braybrook D, Roberts J, Gafni A, Taylor A. Case management community care for people living with HIV/AIDS (PLHAs). AIDS Care 2007; 19:1065-72.

A case management approach to support services was developed in a Toronto-based AIDS service organization in Canada to support people living with HIV whose needs could not be addressed through usual self-directed access to services. It was therefore important to determine which persons would benefit most from case management. New clients and those who had been receiving support services from an AIDS service organization were randomized to receive either self-directed use of support services or self-directed care plus strengths-based case management for a six-month period. Those who benefited most from case management were very depressed at baseline. Strengths-based case management compared to usual self-directed care markedly improved the physical, social, and mental health function of very depressed persons living with HIV, and reduced their risk behaviours. In addition, the case management participants’ use of community services was associated with an economically important, though not statistically significant, $3,300 per person per annum lower expenditure for the use of all direct health and social services. Although more research is warranted, this research demonstrates that AIDS service organizations and funders ought to seriously consider implementing a case management approach to practical assistance for persons living with HIV with depression.

Editors’ note: Placing very depressed patients with a case manager who can assist them in becoming functional was found to be good value for money invested and improved quality of life. The lower expenditure on all services used by people living with HIV who received case management more than offset the cost of case managers, under a system of national health care insurance.