HIV Prevention Program among Substance Abusing 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。在SMI中，艾滋病毒/艾滋病的相对风险至少是费城普通医疗补助人口的五倍，也是那些同时接受药物滥用治疗的人的七倍以上。SMI患者报告了更多通过异性接触、注射吸毒(IDU)的传播，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。我们将对同时滥用药物的SMI患者实施预防计划。一项全面的试点研究令人信服地表明，SMI参与者能够从教授艾滋病毒预防技能的病例管理人员那里学习。通过健康预防艾滋病(PATH)是两个艾滋病毒预防方案的翻译，事实证明，这两个方案在普通人群和药物使用者中有效。尊重计划是由疾控中心开发的，是第一个在多个地点展示一对一咨询可以减少高危性行为的艾滋病毒预防计划。NIDA以社区为基础的外展模式(CBOM)旨在降低吸毒者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、人性化的干预措施。PATH使用案例经理(CMS)根据个人消费者风险概况利用两种干预措施的功能。CMS在向这一人群提供服务方面拥有专门知识。我们相信，这种专业知识、与这些人以前的关系以及定期加强干预的能力将显著降低风险。血液检测将确定那些在基线时艾滋病毒呈阳性的人。呼气测定仪和尿液测试将补充临床访谈和其他措施，以确定药物滥用的共同发病率。采用纵向实验和控制组设计，我们将随机分配病例经理，向符合纳入标准的病例量中同意的参与者提供干预。参与者将在费城的一家大型CMHC接受治疗。将在干预前以及干预后3、6和12个月再次与病例经理和消费者进行独立访谈，重点关注危险行为的变化、干预翻译的保真度、成本和结果。12个月时的呼气测试和尿液测试将补充酒精、可卡因、大麻、苯二氮平和鸦片类药物的使用情况。

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.