HIV Prevention for the Mentally Ill: Motivation-Skills

描述(申请人提供)：患有严重精神疾病(SMI)的人感染艾滋病毒的风险仍然很高。旨在降低这一风险的干预措施只取得了不大的成功，这表明迫切需要为这一人群采取创新的方法。拟议的R34探索性研究拨款(对先前申请的修订)将允许我们调整和完善两项针对SMI患者降低艾滋病毒风险的手动干预措施。我们的主要目标是开发一种“现实世界”的方法，将激励性访谈和传统技能培养干预方面的最新进展结合起来，以降低这一人群的艾滋病毒风险。具体地说，我们将调整现有的艾滋病毒降低风险技能培养干预措施，这些干预措施传统上是以小组形式实施的，适用于个别患者。然后，我们将把激励性访谈技术融入到技能培养干预中，这样我们就能够比较每个干预措施的效果(单独技能培养与综合技能培养和动机访谈干预)，以探索动机访谈技术的整合在多大程度上增强了传统的技能培养干预措施。制定这些干预措施将是该项目的中心重点，利用由消费者和提供者组成的焦点小组和咨询委员会。在项目开发阶段之后，我们将在城市和被剥夺公民权的大约40名艾滋病毒血清阳性和血清阴性的严重精神疾病患者样本中试行这些干预措施，他们中的大多数将是有色人种。参与者将被随机分配到简短的综合技能培养-激励性面谈干预或相同持续时间和会话次数的标准技能培养干预措施。还将审查这些干预措施在减少艾滋病毒危险行为、提高沟通/谈判技能和正确使用避孕套方面的有效程度。还将确定最有可能预测结果的参与者特征。该项目的另一个关键和独特的目标是检查这些干预措施在多大程度上有助于为有艾滋病毒风险的SMI患者提供艾滋病毒咨询和检测。我们期望这种干预措施的改进和中试测试将为我们提供令人信服的大规模临床试验所需的数据和洞察力，我们将通过R01机制进行这项试验。

DESCRIPTION (provided by applicant): People with serious mental illness (SMI) continue to be at high risk for HIV infection. Interventions designed to reduce this risk have been met with only modest success, suggesting a critical need for innovative approaches for this population. The proposed R34 exploratory study grant (a revision of an earlier application) will allow us to adapt and refine two manualized interventions for HIV risk reduction for people with SMI. Our primary aim is to develop a "real world" approach towards reducing HIV risk for this population, integrating recent advances in Motivational Interviewing and traditional Skills-Building interventions. Specifically, we will adapt existing HIV risk reduction Skills Building interventions, which have traditionally been administered in group formats, for use with individual patients. We will then incorporate Motivational Interviewing techniques into the Skills-Building intervention so that we will be able to compare the efficacy of each intervention (Skills-Building alone vs. an integrated Skills-Building and Motivational Interviewing intervention) in order to explore the degree to which integration of Motivational Interviewing techniques augment traditional Skills-Building interventions. Development of these interventions will be a central focus of this project, utilizing focus groups and advisory boards consisting of consumers and providers. Following the development phase of the project, we will pilot-test these interventions with an urban and disenfranchised sample of approximately 40 HIV-seropositive and seronegative men and women with serious mental illness, most of whom will be people of color. Participants will be randomly assigned to a brief, integrated Skills-Building-Motivational Interviewing intervention or to a standard Skills-Building intervention of the same duration and number of sessions. The degree to which these interventions are efficacious in reducing HIV risk behaviors and increasing skills in communication/negotiation and correct condom usage will also be examined. Participant characteristics most likely to predict outcome will also be identified. Another key and unique objective for this project is to examine the degree to which these interventions can be useful in facilitating HIV counseling and testing for people with SMI at risk for HIV. It is our expectation that this intervention refinement and pilot testing will provide us with the data and insight needed for a compelling larger-scale clinical trial, which we will pursue through the R01 mechanism.