Collaborative HIV/AIDS Prevention and Mental Health Treatment Project

描述（由申请人提供）：精神障碍在艾滋病毒感染者中非常普遍，并与负面健康结果以及性和药物风险行为有关。尽管需要解决精神障碍问题，但由于严重的社区、人际和经济障碍，许多艾滋病毒感染者没有接受精神卫生服务。发现在家庭环境中提供的心理健康服务减少了获得护理的障碍，改善了老年人和严重精神病患者的治疗结果；然而，在治疗艾滋病毒感染者方面，以家庭为基础的心理健康治疗很少受到重视。目的：以社区为基础的参与式研究（CBPR）方法将用于设计、实施和评估以家庭为基础的精神卫生治疗干预措施，以治疗可能同时存在物质使用问题的艾滋病毒/艾滋病和精神障碍患者。这项研究涉及杜克大学卫生政策中心与区域艾滋病毒/艾滋病联合会（一个服务于北卡罗来纳州中南部的艾滋病毒/艾滋病服务组织）在所有研究方面的伙伴关系，以及与艾滋病毒阳性个人和社区代表的合作。研究目标包括：a)使用社区流程，包括hiv阳性个体、社区咨询委员会和社区利益相关者，以适应一种基于证据的治疗模式——疾病管理和康复，用于hiv阳性个体；2)测试该项目招募、保留个人并将其与现有心理健康服务联系起来进行长期护理的能力；3)检查参与是否与风险行为减少的趋势有关。4)通过共同学习机会提高合作伙伴的CBPR能力，并通过评估目标实现情况和调查社区合作伙伴来评估合作伙伴关系和CBPR过程。研究设计：40人将通过标准化的心理健康筛查招募他们的医疗提供者在地区传染病诊所和转诊由社会服务提供者。参与者必须是艾滋病毒阳性，有主要的DSM IV轴I精神障碍，21岁或以上，居住在研究地区，并且没有接受精神卫生保健。在9个月的时间里，参与者将接受家庭心理健康治疗，该治疗还将酌情处理药物使用和减减性/毒品风险问题，这是由CBPR进程设计的。意义：本研究结果将为更严格地检验社区心理健康治疗干预在改善预后方面的有效性提供R01基础。从社区伙伴和艾滋病毒/艾滋病患者那里获得的关于参加现有精神卫生服务的障碍的信息将用于通报R01，其中将包括解决这些问题的战略。该R21还将有助于改善艾滋病毒和精神障碍患者的生活，并巩固研究机构与社区组织之间的伙伴关系。

DESCRIPTION (provided by applicant): Mental disorders are highly prevalent among HIV-infected individuals and are associated with negative health outcomes and sexual and drug risk behaviors. Despite the need to address mental disorders, many HIV-infected individuals are not receiving mental health services due to significant community, interpersonal, and financial barriers. Mental health services provided in the home environment have been found to reduce barriers to care and improve outcomes in the elderly and the severely mentally ill; however, home-based mental health treatment has received little attention in the treatment of HIV-infected individuals. OBJECTIVE: A community-based participatory research (CBPR) approach will be used to design, implement, and evaluate a home-based mental health treatment intervention for individuals with HIV/AIDS and mental disorders who may also have substance use problems. The study involves a partnership in all research aspects between the Center for Health Policy at Duke University and the Regional HIV/AIDS Consortium, an HIV/AIDS services organization serving southcentral North Carolina, as well as collaboration with HIV-positive individuals and community representatives. Study objectives include a) use of a community process, involving HIV-positive individuals, community advisory board, and community stakeholders, to adapt an evidence-based treatment model, Illness Management and Recovery, for use with HIV-positive individuals, 2) test the ability of the program to recruit, retain, and link individuals with existing mental health services for longer term care, 3) examine whether participation is associated with trends for reduction in risk behavior, psychiatric symptoms, and substance use and 4) increase the CBPR capacity of partners through co-learning opportunities and evaluate the partnership and CBPR process by assessing goal attainment and surveying community partners. RESEARCH DESIGN: Forty individuals will be recruited through standardized mental health screening by their medical providers at area Infectious Diseases Clinics and referral by social service providers. Participants must be HIV-positive, have a major DSM IV Axis I mental disorder, be 21 or older, reside in the study region, and not be receiving mental health care. For 9 months, participants will receive in-home mental health treatment, which will also address substance use and sexual/ drug risk reduction as applicable, designed by the CBPR process. SIGNIFICANCE: The results of this study will serve as a foundation for an R01 to more rigorously test the effectiveness of the community-based mental health treatment intervention in improving outcomes. Information acquired from community partners and individuals with HIV/AIDS regarding barriers to participating in existing mental health services will be used inform the R01, which will include strategies for addressing these concerns. This R21 will also serve to improve the lives of individuals with HIV and mental disorders and to solidify the partnership between the research and community organizations. PUBLIC HEALTH RELEVANCE: The project seeks to adapt and implement the evidence-based Illness Management and Recovery (IMR) mental health treatment model for use in with HIV-infected individuals with mental disorders and to test whether participation in the treatment program is associated with trends for greater motivation for addressing mental health issues and reduction in psychiatric symptoms, substance use, and HIV risk behavior. The project will use a community-based participatory research approach, which will involve a partnership between the Center for Health Policy at Duke University and the Regional HIV/AIDS consortium, a HIV/AIDS planning and services provision organization in North Carolina, as well as collaboration with community advisory board members and community stakeholders involved in HIV care and prevention and other related services in Mecklenburg County North Carolina. Approximately 40 individuals with HIV and mental illness will receive mental health treatment in their home or place of their choosing for 9 months.