HIV/AIDS, Severe Mental Illness and Homelessness

艾滋病毒/艾滋病、严重精神疾病和无家可归

• 批准号: 7928548
• 负责人: STEPHEN MICHAEL BRADY
• 金额: $ 52.63万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-05 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7928548
• 关键词: AIDS prevention; AIDS/HIV problem; Activities of Daily Living; Adult; Attention; Behavior; Caring; Characteristics; Cognitive; Color; Complex; Counseling; Drug usage; Effectiveness; Frequencies; HIV; HIV Infections; Health behavior change; Homelessness; Hour; Housing; Human immunodeficiency virus test; Incidence; Individual; Intervention; Life; Measures; Medical center; Mental disorders; Mentally Ill Persons; Modeling; Motivation; Needles; Outcome; Participant; Patients; Pharmaceutical Preparations; Pilot Projects; Population; Preventive Intervention; Privacy; Provider; Race; Randomized; Randomized Controlled Trials; Recording of previous events; Recovery; Recruitment Activity; Research; Review Literature; Risk; Risk Behaviors; Risk Reduction; Sampling; Secondary Prevention; Services; Sex Orientation; Structure; Techniques; Testing; Time; Translating; Woman; Work; arm; behavior change; brief intervention; care seeking; design; experience; flexibility; follow-up; group intervention; innovation; men; motivational enhancement therapy; novel; physical abuse; primary outcome; programs; public health relevance; safety net; severe mental illness; sex; skills; therapy design; treatment as usual; treatment response

DESCRIPTION (provided by applicant): This is a two-arm randomized controlled trial (RCT) for 308 seriously mentally ill adults (SMI) engaging in risky sexual and/or drug use behavior comparing a brief HIV primary and secondary prevention intervention [Skills building and Motivational Interviewing (SB-MI) to Care as Usual (CAU)]. Outcomes will be measured at 3, 6, and 12 months. The SB-MI intervention (3 sessions + booster) was initially developed as the experimental condition in an R34 pilot project which demonstrated its feasibility and promise. For the proposed project, we will recruit a larger sample which includes men and women, with and without HIV, from various ethnic and racial groups, different sexual orientations and housing arrangements, a range of psychiatric disorders and functional capacities. In this way we can more rigorously demonstrate the promise of SB-MI for diverse people with SMI. We will also conduct a sub-study after the 6 month follow-up to examine the impact at 12 months of an additional booster session for SB-MI participants. Our primary aim is to examine the effectiveness of a brief, tailored primary and secondary risk reduction strategy to CAU for people with serious mental illness. The desired outcomes for this aim include: decreased frequency of risk behaviors (number of partners, number of encounters); increased use of barrier precautions and IV needle cleaning; positive changes in information, motivation, and risk behaviors associated with HIV and increased HIV Counseling and Testing for those who do not know their HIV status. A second aim is to examine the effectiveness of a 2nd booster session after the 6 month follow-up for 1/2 of participants randomized to SB-MI. The primary outcome will be decreased frequency of risk behaviors and increased use of barrier precautions at the 12 month follow-up for participants who receive a 2nd booster. Our hypotheses include: 1) Effect sizes for constructs of the IMB (Information, Motivation, Behavior) Model will be larger for participants randomized to the SB-MI condition compared to CAU. 2) Participants in SB-MI will demonstrate higher rates of accessing HIV counseling and testing at follow-up, as compared to participants in CAU. 3) SB-MI participants who receive a 2nd booster session will be significantly more likely to maintain behavior change at 12 months compared to SB-MI participants who do not receive the 2nd booster. Our long-term objective is to reduce the incidence of HIV risk behavior for SMI using a brief intervention which can be easily translated and adapted to "real world" settings. PUBLIC HEALTH RELEVANCE: Research findings increasingly support the contention that the incidence of HIV infection is high among people with serious mental illness (SMI). Our long-term objective is to reduce the incidence of HIV risk behavior for SMI using a brief intervention which can be easily translated and adapted to "real world" settings.

描述（由申请人提供）：这是一项针对308名从事危险性行为和/或吸毒行为的严重精神病成人（SMI）的双臂随机对照试验（RCT），比较了简短的HIV一级和二级预防干预[技能培养和动机访谈（SB-MI）与护理作为个体（CAU）]。将在3、6和12个月时测量结局。SB-MI干预（3个疗程+加强剂）最初是作为R34试点项目的实验条件开发的，该项目证明了其可行性和前景。对于拟议的项目，我们将招募更大的样本，其中包括来自不同种族和种族群体、不同性取向和住房安排、一系列精神障碍和功能能力的男性和女性，包括艾滋病毒感染者和未感染者。通过这种方式，我们可以更严格地证明SB-MI对不同的SMI患者的承诺。我们还将在6个月随访后进行一项子研究，以检查SB-MI参与者额外加强治疗12个月的影响。 我们的主要目的是检查一个简短的，量身定制的主要和次要风险降低策略的有效性，以CAU的人有严重的精神疾病。这一目标的预期结果包括：降低风险行为的频率（伴侣数量，接触次数）;增加屏障预防措施和静脉注射针头清洁的使用;与艾滋病毒相关的信息，动机和风险行为的积极变化，以及为那些不知道自己艾滋病毒状况的人提供更多的艾滋病毒咨询和检测。第二个目的是在6个月随访后检查1/2随机分配至SB-MI的参与者的第二次加强治疗的有效性。主要结局将是在12个月随访时，接受第二次加强的参与者的风险行为频率降低，屏障预防措施的使用增加。我们的假设包括：1）与CAU相比，IMB（信息，动机，行为）模型结构的效应量对于随机分配到SB-MI条件的参与者将更大。2)与CAU的参与者相比，SB-MI的参与者在随访时获得艾滋病毒咨询和检测的比率更高。3)与未接受第二次助推器的SB-MI参与者相比，接受第二次助推器的SB-MI参与者在12个月时更有可能保持行为变化。 我们的长期目标是通过一种简单的干预措施来降低重度精神病感染者的艾滋病毒风险行为的发生率，这种干预措施可以很容易地翻译和适应“真实的世界”的环境。 公共卫生相关性：研究结果越来越支持这样一种论点，即在患有严重精神疾病的人中，艾滋病毒感染率很高。我们的长期目标是通过一种简单的干预措施来降低重度精神病感染者的艾滋病毒风险行为的发生率，这种干预措施可以很容易地翻译和适应“真实的世界”的环境。