Collaborative HIV/AIDS Prevention and Mental Health Treatment Project

Duke University, Durham NC

Investigators

Linked publications & trials

Abstract

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.