Brazilian HIV Prevention for the Severely Mentally Ill

描述(申请人提供)：严重精神病患者(SMI) 已发现患人类免疫缺陷的风险极高 病毒(HIV)--4%至23%的血清阳性率--在美国需要解决 针对这一人群的特殊需求，几项艾滋病毒预防干预措施 经过测试，发现对SMI是有效的。尽管有很好的记录 巴西的艾滋病危机和巴西政府？S致力于艾滋病毒 全社会预防，巴西SMI不定期提供艾滋病毒 预防干预措施。在巴西精神病学环境中进行的两项小型研究 记录了SMI患者的性风险行为。裁剪效果显著 对巴西SMI的预防干预可能会促进 将艾滋病毒预防方案纳入精神卫生保健系统。 这项研究的目标是适应、改进和试点提供者提供的艾滋病毒 在巴西对患有SMI的男性和女性进行预防干预，以便：(1) 将技能传授给巴西的精神卫生保健提供者(MHCP)以提供 为他们的SMI客户提供艾滋病毒预防干预；以及(2)帮助这些 客户减少了他们的艾滋病毒危险行为。这项研究将进行 由经验丰富的调查人员组成的美国-巴西团队合作。这项研究 将由ABIA管理，ABIA是一个基于社区的组织，致力于 在巴西以民族志为基础的艾滋病毒预防，并在 里约热内卢联邦大学研究所(UFRJ/iPub)， 一家学术精神病学机构，负责直接护理大型 精神科门诊人数。我们建议进行形成性研究， UFRJ/iPub的巴西MHCP和精神病患者，将包括 人种学观察/评估和有关键线人的焦点小组 (MHCP和男性和女性精神科门诊患者)，将用于 针对SMI人群的需求量身定做现有的有效干预措施 巴西。改进的干预措施将在患有以下疾病的男性和女性中进行试点测试 使用过程测量和精神评估的SMI遵循每个 干预会议，以及基线和之后的风险行为评估 三个月。注意力控制干预将被类似地调整， 在一组门诊患者中实施，并使用相同的衡量标准进行评估。 结果将在巴西举行的为期两天的会议上向MHCP公布， 研究人员和心理健康政策制定者(即当地舆论领袖)。 该项目将为设计一项临床试验奠定基础。 在巴西进行了适应性干预。

DESCRIPTION (provided by applicant): People with severe mental illness (SMI) have been found to be at extremely elevated risk for human immunodeficiency virus (HIV) -- 4 percent to 23 percent seroprevalence -- in the U.S. To address the special needs of this population, several HIV prevention interventions have been tested and found to be efficacious for the SMI. Despite a well-documented AIDS crisis in Brazil and the Brazilian government?s commitment to HIV prevention for the whole society, Brazilian SMI are not regularly offered HIV prevention interventions. Two small studies in Brazilian psychiatric settings have documented sexual risk-taking among SMI patients. Tailoring efficacious prevention interventions to the SMI of Brazil is likely to facilitate integration into the mental health care system of HIV prevention programming. The goal of this study is to adapt, refine, and pilot a provider-delivered HIV prevention intervention for men and women with SMI in Brazil in order to: (1) impart skills to mental health care provider about (MHCPs) in Brazil to deliver an HIV prevention intervention for their SMI clients; and (2) help these clients reduce their HIV risk behaviors. This study will be undertaken collaboratively by a US-Brazil team of experienced investigators. The study will be administered by ABIA, a community-based organization dedicated to ethnographically-based HIV prevention in Brazil, and carried out at the Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (UFRJ/IPUB), an academic psychiatric institute with direct-care responsibilities for a large number of psychiatric outpatients. We propose to conduct formative studies with Brazilian MHCPs and psychiatric patients at the UFRJ/IPUB, to consist of ethnographic observations/assessment and focus groups with key informants (MHCPs and male and female psychiatric outpatients), which will be used to tailor extant efficacious interventions to the needs of the SMI population in Brazil. The refined intervention will be pilot-tested with men and women with SMI using process measures and psychiatric assessments following every intervention session, as well as risk behavior assessment at baseline and after 3 months. An attention control intervention will be similarly adapted, implemented with a group of outpatients, and assessed using the same measures. Results will be disseminated in 2-day conference in Brazil to MHCPs, researchers, and mental health policy makers (i.e., local opinion leaders). This project will lay the groundwork for designing a clinical trial of the adapted intervention in Brazil.