Brazilian HIV Prevention for the Severely Mentally Ill

描述（由申请人提供）：患有严重精神疾病（SMI）的人 患有人类免疫缺陷的风险极高 艾滋病毒（HIV）--4%到23%的血清阳性率--在美国。 鉴于这一人群的特殊需要，一些艾滋病毒预防干预措施已 经过测试，发现对SMI有效。尽管有充分的证据证明 艾滋病危机在巴西和巴西政府？对艾滋病毒的承诺 由于整个社会都在预防艾滋病毒，巴西的性工作者和性工作者没有定期获得艾滋病毒服务， 预防干预。在巴西精神病学环境中进行的两项小型研究 已经记录了重度精神障碍患者的性冒险行为。剪裁灵验 对巴西SMI的预防干预可能会促进 将艾滋病毒预防方案纳入精神卫生保健系统。 这项研究的目标是调整，完善和试点提供者提供的艾滋病毒 对巴西患有重度精神分裂症的男性和女性进行预防干预，以便：（1） 向巴西精神卫生保健提供者传授技能， 为他们的SMI客户提供艾滋病毒预防干预;（2）帮助这些 减少艾滋病毒的危险行为。这项研究将在 由经验丰富的美国-巴西调查团队合作。研究 将由阿比亚管理，ABIA是一个社区组织，致力于 在巴西开展的基于人种学的艾滋病毒预防工作， 里约热内卢联邦大学心理学研究所， 一个学术精神病研究所，直接负责大型 精神科门诊病人人数。我们建议进行形成性研究， UFRJ/IPUB的巴西MHCP和精神病患者，包括 人种学观察/评估和有关键信息提供者的重点小组 （MHCP和男性和女性精神科门诊患者），将用于 根据重度精神疾病人群的需要， 巴西将在男性和女性中对改进后的干预进行试点测试， SMI使用过程测量和精神评估， 干预会议，以及基线和之后的风险行为评估 3个月注意力控制干预也将进行类似的调整， 对一组门诊患者实施，并使用相同的措施进行评估。 结果将在巴西举行的为期两天的会议上分发给卫生保健专业人员， 研究人员和心理健康政策制定者（即，地方舆论领袖）。 该项目将为设计一项临床试验奠定基础， 在巴西进行了适应性干预。

DESCRIPTION (provided by applicant): People with severe mental illness (SMI) have been found to be at extremely elevated risk for human immunodeficiency virus (HIV) -- 4 percent to 23 percent seroprevalence -- in the U.S. To address the special needs of this population, several HIV prevention interventions have been tested and found to be efficacious for the SMI. Despite a well-documented AIDS crisis in Brazil and the Brazilian government?s commitment to HIV prevention for the whole society, Brazilian SMI are not regularly offered HIV prevention interventions. Two small studies in Brazilian psychiatric settings have documented sexual risk-taking among SMI patients. Tailoring efficacious prevention interventions to the SMI of Brazil is likely to facilitate integration into the mental health care system of HIV prevention programming. The goal of this study is to adapt, refine, and pilot a provider-delivered HIV prevention intervention for men and women with SMI in Brazil in order to: (1) impart skills to mental health care provider about (MHCPs) in Brazil to deliver an HIV prevention intervention for their SMI clients; and (2) help these clients reduce their HIV risk behaviors. This study will be undertaken collaboratively by a US-Brazil team of experienced investigators. The study will be administered by ABIA, a community-based organization dedicated to ethnographically-based HIV prevention in Brazil, and carried out at the Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (UFRJ/IPUB), an academic psychiatric institute with direct-care responsibilities for a large number of psychiatric outpatients. We propose to conduct formative studies with Brazilian MHCPs and psychiatric patients at the UFRJ/IPUB, to consist of ethnographic observations/assessment and focus groups with key informants (MHCPs and male and female psychiatric outpatients), which will be used to tailor extant efficacious interventions to the needs of the SMI population in Brazil. The refined intervention will be pilot-tested with men and women with SMI using process measures and psychiatric assessments following every intervention session, as well as risk behavior assessment at baseline and after 3 months. An attention control intervention will be similarly adapted, implemented with a group of outpatients, and assessed using the same measures. Results will be disseminated in 2-day conference in Brazil to MHCPs, researchers, and mental health policy makers (i.e., local opinion leaders). This project will lay the groundwork for designing a clinical trial of the adapted intervention in Brazil.