HIV Prevention Program among Substance Abusing SMI

描述（由申请人提供）：患有严重精神疾病（SMI）的人感染艾滋病毒/艾滋病的风险增加。在费城，重度精神分裂症患者感染艾滋病毒/艾滋病的相对风险至少是接受医疗补助的普通人群的5倍，而那些也接受药物滥用治疗的人群的相对风险则超过7倍。据报道，重度精神分裂症患者通过异性性接触、注射吸毒（IDU）以及女性与男男性行为者（MSM）发生的性行为比一般人群更多。一项成本研究表明，感染艾滋病毒的重度精神残疾者的医疗费用远高于感染艾滋病毒的非重度精神残疾者和感染艾滋病毒的重度精神残疾者。我们将对滥用药物的严重精神障碍患者实施预防方案。一项全面的试点研究令人信服地表明，SMI参与者能够向教授艾滋病毒预防技能的病例管理人员学习。通过健康预防艾滋病（PATH）是两个艾滋病毒预防方案的翻译，在一般人群和药物使用者中证明是有效的。RESPECT项目由美国疾病控制与预防中心开发，是首个在多地点示范中展示一对一咨询可以减少高危性行为的艾滋病毒预防项目。NIDA社区外展模式（CBOM）旨在降低吸毒者感染艾滋病毒和其他血液传播感染的风险。两者都是高度结构化的人工干预。适宜卫生技术方案利用病例管理人员（CMs）根据个人消费者风险概况，利用这两种干预措施的特点。CMs在为这一人群提供服务方面具有专业知识。我们相信，这种专业知识、与这些人之前的关系，以及定期加强干预的能力，将显著降低风险。血液检测将确定哪些人在基线时是艾滋病毒阳性。酒精和尿液测试将补充临床访谈和其他措施，以确定药物滥用合并症。采用纵向实验和对照组设计，我们将随机分配病例管理人员，将干预措施交付给符合纳入标准的病例中同意的参与者。参与者将在费城的一家大型CMHC接受治疗。在干预前和干预后3个月、6个月和12个月分别对个案管理者和消费者进行独立访谈，重点关注风险行为的变化、干预翻译的保真度、成本和结果。12个月时的酒精和尿液测试将补充酒精、可卡因、大麻、苯二氮卓类药物和阿片类药物使用情况的自我报告。

DESCRIPTION (provided by applicant): Persons with serious mental illness (SMI) are at increased risk for HIV/AIDS. The relative risk of HIV/AIDS is at least five times greater in SMI as the general Medicaid population in Philadelphia and over seven times for those also treated for substance abuse. SMI persons reported more transmissions through heterosexual contact, injection drug use (IDU), and women have more sex with men who have sex with men (MSM) than in the general population. A cost study showed that SMI with HIV had much higher health care costs than non-SMI persons with HIV and non-HIV persons with SMI. We will implement a prevention program for persons with SMI who also abuse substances. A comprehensive pilot study demonstrated convincingly that SMI participants were able to learn from case managers teaching HIV prevention skills. Preventing AIDS through Health (PATH) is a translation of two HIV prevention programs proven effective in the general population and among substance users. The RESPECT program was developed by CDC and is the first HIV prevention program to show one-on-one counseling can reduce at-risk sexual behavior in a multi-site demonstration. The NIDA Community-Based Outreach Model (CBOM) was designed to reduce the risk of HIV and other blood-borne infections in drug users. Both are highly structured, manualized interventions. PATH uses case managers (CMs) to draw on features of both interventions depending on individual consumer risk profiles. CMs have specialized expertise in providing services to this population. We believe that this expertise, prior relationships with these persons, and an ability to reinforce regularly the intervention will result in significantly reduced risk. Blood testing will identify those who are HIV positive at baseline. Breathalyzer and urine testing will supplement clinical interviews and other measures to identify substance abuse co-morbidity. Using a longitudinal experimental and control group design, we will randomly assign case managers to deliver the intervention to consenting participants in their caseloads who meet inclusion criteria. Participants will be in treatment at a large CMHC in Philadelphia. Independent interviews will be conducted with case managers and consumers before the intervention, and again at 3, 6 and 12-months post intervention and focus on changes in risk behaviors, fidelity of translation of the intervention, cost and outcomes. Breathalyzer and urine tests at 12-months will supplement self-reports of use of alcohol, cocaine, marijuana, benzodiazapines, and opiates.