Nursing Intervention for HIV Regimen Adherence among SMI

描述(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。SMI人群感染艾滋病毒/艾滋病的相对风险至少是费城普通医疗补助人群的五倍，我们估计SMI人群中高达7%的人也是HIV血清阳性。SMI患者报告通过异性接触和注射吸毒(IDU)传播更多，SMI女性与男男性行为者(MSM)的性行为比一般人群更多。一项成本研究表明，患有艾滋病毒的SMI患者的医疗费用比非SMI患者和非SMI患者的医疗费用高得多。有人担心，艾滋病毒阳性的SMI患者治疗依从性差的风险可能更大，结果更差和出现治疗抗药性病毒的风险更大，也会使其他人面临更大的风险。药物使用和抑郁已被证明会干扰艾滋病毒治疗的坚持。先前已证明，高级执业护士的参与可以改善艾滋病毒/艾滋病患者的治疗结果。由于病例经理(CMS)已经参与协调这一人群的心理健康、社会和其他服务，并在提供这些服务方面拥有专业知识，我们相信整合护理和病例管理的综合服务模式将以CD4和病毒载量为指标产生明显更好的艾滋病毒治疗结果，并通过标准化的行为自我报告显著减少危险行为。参与者将从已经在费城四家大型城市CMHC之一接受SMI治疗的患者中招募。采用纵向(基线、6、12和24个月)实验和控制组设计，我们将300名参与者随机分配到干预组或控制组。参与者将接受主动药物滥用和抑郁的筛查，随机，实验参与者将接受针对个人沟通和理解而量身定做的综合干预，包括记忆辅助设备、关于副作用和其他治疗方面的教育，以及积极的社区宣传。对于那些未能坚持使用基本干预措施的人，将实施增加强度的级联治疗。以80%的坚持为目标，级联将包括家人和重要其他人的参与，通过使用寻呼机和手机来提示参与者，对于那些仍然没有达到80%坚持的人，直接观察治疗。

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 we estimate that up to 7% of the SMI population is also HIV seropositive. SMI persons reported more transmissions through heterosexual contact and injection drug use (IDU), and SMI 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. There is concern that HIV positive SMI persons may be a greater risk for poor treatment adherence, increasing risk for poorer outcomes and development of treatment resistant virus, and also placing others at greater risk. Substance use and depression have been shown to interfere with HIV treatment adherence. Involvement of advance practice nurses (APNs) has been previously shown to improve outcomes for persons with HIV/AIDS. Since case managers (CMs) are already involved with coordinating mental health, social, and other services for this population and have specialized expertise in providing those services, we believe that an integrated services model that integrates nursing and case management will result in demonstrably better HIV treatment outcomes using CD4 and viral load as indicators, and significantly reduced risk behaviors using standardized behavioral self-reports. Participants will be recruited from among those already in treatment for SMI in one of four large urban CMHC's in Philadelphia. Using a longitudinal (baseline, 6,12, and 24 months) experimental and control group design, we will randomly assign 300 participants to the intervention or control groups. Participants will be screened for active substance abuse and depression, randomized, and experimental participants will receive an integrated intervention tailored to the communication and comprehension of the individual, and will include memory aid devices, education regarding side effects and other treatment aspects, and active community outreach. For those who fail to adhere using the basic intervention, a treatment cascade that increases in intensity will be implemented. Using 80% adherence as a target, the cascade will include involvement of family and significant others in prompting participants through use of beepers, cellphones, and for those who still fall short of 80% adherence, directly observed therapy.