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.
A community-based participatory research (CBPR) approach will be used to design, implement, and evaluate a home-based mental health treatment and HIV risk reduction intervention for individuals with HIV/AIDS and mental disorders who may also have substance abuse problems. The project involves a partnership in all aspects of the project between the Center for Health Policy at Duke University and the Regional HIV/AIDS Consortium, an HIV/AIDS planning and services organization serving southcentral North Carolina, as well as collaboration with HIV-positive individuals and community representatives. Study objectives include:
- 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,
- test the ability of the program to recruit and retain individuals and link them with existing mental health services for longer term care,
- examine whether participation is associated with trends for reduction in risk behavior, psychiatric symptoms, and substance use and
- increase the CBPR capacity of the research partnership through quarterly co-learning opportunities and evaluate the partnership and CBPR process by assessing goal attainment and surveying community partners.
Participants (n=40) will be referred by HIV medical and social service providers. To participate, individuals must be HIV-positive, have a major DSM IV Axis I mental disorder, be 21 or older, and not receiving ongoing mental health services. Participants will receive mental health treatment designed by the CBPR process for 9 months and HIV prevention case management tailored to their specific prevention needs.
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 and HIV risk reduction 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 RO1, 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.