HIV/AIDS, Severe Mental Illness and Homelessness

描述(由申请人提供)：这是一项针对308名有危险性行为和/或吸毒行为的严重精神病成人(SMI)的双臂随机对照试验(RCT)，比较了简单的HIV一级和二级预防干预[技能培养和动机访谈(SB-MI)与照常护理(CAU)]。将在3个月、6个月和12个月时测量结果。SB-MI干预(3次会议+助推器)最初被开发为R34试点项目的实验条件，证明了其可行性和前景。对于拟议的项目，我们将招募更多的样本，其中包括来自不同族裔和种族、不同的性取向和住房安排、一系列精神障碍和功能能力的男性和女性，无论是否感染艾滋病毒。通过这种方式，我们可以更严格地展示SB-MI对于不同SMI人群的承诺。我们还将在6个月的随访后进行一项子研究，以检查为SB-MI参与者增加一次强化疗程12个月的影响。我们的主要目标是检验一种简短的、量身定制的初级和次级风险降低策略的有效性，以帮助严重精神疾病患者进行治疗。这一目标的预期结果包括：减少危险行为的频率(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、动机和危险行为的积极变化；以及为那些不知道自己艾滋病毒状况的人增加艾滋病毒咨询和检测。第二个目标是在对随机接受SB-MI的1/2参与者进行6个月的随访后，检查第二次强化治疗的有效性。主要结果将是在接受第二次强化治疗的参与者12个月的随访中，危险行为的频率降低和屏障预防措施的使用增加。我们的假设包括：1)与CAU相比，被随机分配到SB-MI条件的参与者在IMB(信息、动机、行为)模型的结构上的效应大小将更大。2)与CAU的参与者相比，SB-MI的参与者在后续的HIV咨询和检测中将表现出更高的获得率。3)与没有接受第二次强化训练的SB-MI参与者相比，接受第二次强化训练的SB-MI参与者在12个月后保持行为改变的可能性明显更大。我们的长期目标是使用一种简单的干预措施来减少SMI的艾滋病毒危险行为的发生率，这种干预措施可以很容易地转换和适应“现实世界”的设置。 公共卫生相关性：研究结果越来越支持这样一种观点，即严重精神疾病(SMI)患者中艾滋病毒感染的发生率很高。我们的长期目标是使用一种简单的干预措施来减少SMI的艾滋病毒危险行为的发生率，这种干预措施可以很容易地转换和适应“现实世界”的设置。

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.