RCT of a Brazilian HIV Prevention Intervention for the SMI

描述（由申请人提供）：在世界范围内，患有严重精神疾病（SMI）的人被发现具有极高的人类免疫缺陷病毒（HIV）风险。最近的一项研究表明，巴西重度精神病人的艾滋病毒血清感染率比一般人群高5倍，几项研究表明重度精神病人有性冒险行为。尽管巴西的艾滋病危机有案可查，巴西政府也致力于全社会的艾滋病预防工作，但巴西的重度精神病患者并没有定期得到艾滋病预防干预措施的检测。本研究的目标是建立在NIMH资助的试点研究（R01-65163-01）的成功发现的基础上，该研究在美国发现对重度精神分裂症有效的艾滋病毒预防干预措施的基础上，对巴西患有重度精神分裂症的男性和女性进行了调整、改进和试点。我们的试点研究确定了进行随机对照试验的必要性和可行性，以测试基于理论、小组、提供者提供的干预措施的有效性，该干预措施侧重于提高知识、动机和行为技能（1MB模型），以减少重度精神障碍患者的艾滋病毒性风险行为。我们建议继续建立我们目前的社区伙伴关系，并扩大合作，包括里约热内卢市的市政当局。巴西里约热内卢的9个市政社区精神卫生诊所（社会心理援助中心）将作为拟议研究的地点。使用具有巴西各地门诊治疗提供环境代表性的站点，将为未来的艾滋病毒预防服务提供信息。我们建议进行一项随机对照试验，以测试我们的巴西艾滋病毒预防干预对重度精神障碍男性和女性的长期疗效（8个疗程加上6个月后的3次强化治疗），在基线、干预后3、6和12个月评估性风险行为；还将评估艾滋病毒知识、动机和行为技能，以及精神病污名和精神症状对性危险行为的影响。我们的合作历史体现了兼容、公平的国际研究合作，以及社区、学术和服务机构成员的双向能力建设伙伴关系。本研究将为今后在巴西精神科护理系统内实施艾滋病毒预防服务奠定基础。此外，如果有效，我们的干预措施——以及我们用来开发它的合作过程——将成为一种模式，可在全球各种公共卫生环境中实施。

DESCRIPTION (provided by applicant): Worldwide, people with severe mental illness (SMI) have been found to be at extremely elevated risk for human immunodeficiency virus (HIV). A recent study has documented an HIV seroprevalence among SMI in Brazil five times higher than the general population and several studies have documented sexual risk- taking among 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 tested HIV prevention interventions. The goal of this study is to build on the successful findings of our NIMH funded pilot study (R01-65163-01) that adapted, refined, and piloted an HIV prevention intervention for men and women with SMI in Brazil, based on HIV prevention interventions found to be efficacious for the SMI in the US. Our pilot study established the need for and feasibility of conducting an RCT to test the efficacy of a theory-based, small-group, provider-delivered intervention that focuses on improving knowledge, motivation, and behavioral skills (1MB Model) to reduce HIV sexual risk behavior among SMI. We propose to continue to build our current community partnerships and to expand the collaboration to include the Municipality of the city of Rio de Janeiro. AH nine municipal community mental health clinics (Centers for Psycho-Social Assistance-CAPS) in Rio de Janeiro will serve as sites for the proposed study. Using sites that are representative of outpatient treatment delivery settings across Brazil, will inform future HIV prevention services. We propose to conduct an RCT to test the long-term efficacy of our Brazilian HIV Prevention Intervention for men and women with SMI (eight sessions plus three boosters six months later) assessing sex risk behavior at baseline, and 3, 6 and 12 months post-intervention; HIV knowledge, motivation and behavioral skills will also be assessed together with the impact of mental illness stigma and psychiatric symptoms on sex risk behavior. Our history of working together exemplifies compatible, equitable international research collaboration and partnership with bidirectional capacity building of community, academic and service setting members. This study will lay a foundation for future HIV prevention services implementation within the system of psychiatric care in Brazil. Further, if efficacious, our intervention-and the process of collaboration we used to develop it-will be a model that can be implemented in a variety of public health settings worldwide.