Collaborative HIV/AIDS Prevention and Mental Health Treatment Project

描述(申请人提供)：精神障碍在艾滋病毒感染者中非常普遍，并与消极的健康结果以及性和药物危险行为有关。尽管需要解决精神障碍，但由于重大的社区、人际和经济障碍，许多艾滋病毒感染者没有得到精神卫生服务。已发现，在家庭环境中提供精神健康服务可以减少老年人和严重精神病患者的护理障碍，改善结果；然而，在艾滋病毒感染者的治疗中，以家庭为基础的精神健康治疗很少受到重视。目的：以社区为基础的参与性研究(CBPR)方法将被用来设计、实施和评估针对HIV/AIDS和精神障碍患者的家庭心理健康治疗干预措施，这些患者可能也有药物使用问题。这项研究涉及杜克大学卫生政策中心与为北卡罗来纳州中南部提供服务的艾滋病毒/艾滋病服务组织区域艾滋病毒/艾滋病联合会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)利用社区程序，让艾滋病毒阳性个人、社区顾问委员会和社区利益相关者参与，以适应针对艾滋病毒阳性个人的循证治疗模式、疾病管理和康复；2)测试该计划招募、保留个人并将其与现有的精神卫生服务联系起来以提供长期护理的能力；3)检查参与是否与减少风险行为、精神症状和药物使用的趋势有关；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伙伴关系和CBPR过程。研究设计：通过地区传染病诊所医疗服务提供者的标准化心理健康筛查和社会服务提供者的转介，招募40名个体。参与者必须是HIV阳性者，患有严重的DSM IV Axis I精神障碍，年龄在21岁或以上，居住在研究地区，并且没有接受精神卫生保健。参与者将接受为期9个月的家庭心理健康治疗，还将根据CBPR程序设计，酌情解决药物使用和减少性/药物风险的问题。意义：这项研究的结果将作为R01更严格地测试以社区为基础的心理健康治疗干预在改善结果方面的有效性的基础。从社区合作伙伴和艾滋病毒/艾滋病患者个人那里获得的有关参与现有精神卫生服务障碍的信息将被用于向R01通报，R01将包括解决这些关切的战略。R21还将有助于改善艾滋病毒和精神障碍患者的生活，并巩固研究和社区组织之间的伙伴关系。 公共卫生相关性：该项目寻求调整和实施循证疾病管理和康复(IMR)精神健康治疗模式，用于患有精神障碍的艾滋病毒感染者，并测试参与治疗计划是否与更大的动机解决精神健康问题和减少精神症状、药物使用和艾滋病毒风险行为的趋势相关。该项目将采用以社区为基础的参与性研究方法，其中将涉及杜克大学卫生政策中心与北卡罗来纳州艾滋病毒/艾滋病规划和服务提供组织区域艾滋病毒/艾滋病联盟之间的伙伴关系，以及与北卡罗来纳州梅克伦堡县参与艾滋病毒护理和预防及其他相关服务的社区咨询委员会成员和社区利益攸关方的合作。大约40名患有艾滋病毒和精神疾病的人将在他们选择的家或地方接受为期9个月的心理健康治疗。

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.