HIV Prevention Program among Substance Abusing SMI

描述（由申请人提供）：患有严重精神疾病（SMI）的人感染艾滋病毒/艾滋病的风险增加。 在SMI，艾滋病毒/艾滋病的相对风险至少是费城一般医疗补助人群的五倍，而对于那些也接受药物滥用治疗的人来说，风险超过七倍。 与一般人群相比，重度精神病感染者报告通过异性接触、注射毒品（IDU）和女性与男男性行为者（MSM）发生更多性行为而传播。 一项费用研究表明，感染艾滋病毒的重度接触者的保健费用比感染艾滋病毒的非重度接触者和感染重度接触者的非艾滋病毒者高得多。 我们将为同时滥用药物的重度精神障碍患者实施预防方案。 一项全面的试点研究令人信服地表明，工作人员管理倡议的参与者能够从传授艾滋病毒预防技能的个案管理人员那里学到东西。 通过健康预防艾滋病（PATH）是两个艾滋病毒预防计划的翻译，在普通人群和药物使用者中证明是有效的。 该计划是由CDC开发的，是第一个艾滋病毒预防计划，以显示一对一的咨询可以减少风险性行为在多个地点的示范。 NIDA基于社区的外展模式（CBOM）旨在降低吸毒者感染艾滋病毒和其他血液传播感染的风险。 两者都是高度结构化的手动干预。 适宜卫生技术方案利用个案管理员，根据个人消费者的风险状况，利用这两种干预措施的特点。 社区管理员在向这一群体提供服务方面具有专门知识。 我们相信，这种专业知识，与这些人的先前关系，以及定期加强干预的能力，将导致显着降低风险。 血液检测将确定那些在基线时艾滋病毒呈阳性的人。 呼吸测醉器和尿液测试将补充临床访谈和其他措施，以确定药物滥用合并症。 使用纵向实验和对照组设计，我们将随机分配病例管理员提供干预同意参与者在他们的案例中谁符合纳入标准。 参与者将在费城的一个大型CMHC接受治疗。 在干预前，将与个案经理和消费者进行独立访谈，并在干预后3个月、6个月和12个月再次进行访谈，重点关注风险行为的变化、干预措施的忠实度、成本和结果。 12个月时的呼气测醉和尿检将补充酒精、可卡因、大麻、苯二氮卓类药物和阿片类药物使用的自我报告。

DESCRIPTION (provided by applicant): Persons with serious mental illness (SMI) are at increased risk for HIV/AIDS. The relative risk of HIV/AIDS is at least five times greater in SMI as the general Medicaid population in Philadelphia and over seven times for those also treated for substance abuse. SMI persons reported more transmissions through heterosexual contact, injection drug use (IDU), and women have more sex with men who have sex with men (MSM) than in the general population. A cost study showed that SMI with HIV had much higher health care costs than non-SMI persons with HIV and non-HIV persons with SMI. We will implement a prevention program for persons with SMI who also abuse substances. A comprehensive pilot study demonstrated convincingly that SMI participants were able to learn from case managers teaching HIV prevention skills. Preventing AIDS through Health (PATH) is a translation of two HIV prevention programs proven effective in the general population and among substance users. The RESPECT program was developed by CDC and is the first HIV prevention program to show one-on-one counseling can reduce at-risk sexual behavior in a multi-site demonstration. The NIDA Community-Based Outreach Model (CBOM) was designed to reduce the risk of HIV and other blood-borne infections in drug users. Both are highly structured, manualized interventions. PATH uses case managers (CMs) to draw on features of both interventions depending on individual consumer risk profiles. CMs have specialized expertise in providing services to this population. We believe that this expertise, prior relationships with these persons, and an ability to reinforce regularly the intervention will result in significantly reduced risk. Blood testing will identify those who are HIV positive at baseline. Breathalyzer and urine testing will supplement clinical interviews and other measures to identify substance abuse co-morbidity. Using a longitudinal experimental and control group design, we will randomly assign case managers to deliver the intervention to consenting participants in their caseloads who meet inclusion criteria. Participants will be in treatment at a large CMHC in Philadelphia. Independent interviews will be conducted with case managers and consumers before the intervention, and again at 3, 6 and 12-months post intervention and focus on changes in risk behaviors, fidelity of translation of the intervention, cost and outcomes. Breathalyzer and urine tests at 12-months will supplement self-reports of use of alcohol, cocaine, marijuana, benzodiazapines, and opiates.