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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
 
5126.0: Wednesday, December 14, 2005 - 1:30 PM

Abstract #102382

An Alternative to Traditional Approaches to HIV Prevention for Persons with Mental Illness: The Intervention Cascade

Michael B. Blank, PhD, Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market Street, Room 3020, Philadelphia, PA 19104, 215-349-8488, mblank2@mail.med.upenn.edu

Recent studies highlight increased HIV infection rates in persons with serious mental illness. Estimated prevalence of HIV among Medicaid recipients in Philadelphia with an SMI diagnosis was 7%. We also found 15% of persons treated for HIV were concurrently receiving services for a serious mental illness (Blank et al., 2002). In 2001, the Institute of Medicine concluded that HIV prevention programming did not reflect the current, more nuanced understanding that we have of HIV pathogenesis in different populations, opting instead for a uniform, “one-size-fits-all approach”. We will describe a randomized clinical trial of an adherence intervention that uses an “intervention cascade” where advanced practice nurses provide in-home services to HIV+ consumers who are also seriously mentally ill and coordinate care with other service providers. The intervention cascade is used to titrate the intensity (and expense) of the intervention to actual adherence outcomes. If adherence falls below 80%, the next level in the intervention cascade is implemented until 80% adherence is maintained. A basic intervention consisting of psycho-education as well as instruction on how to used pillboxes and beeping watches is provided to experimental participants. The next step involves activation of social networks, followed by use of alphanumeric beepers, then prepaid cellular phones to encourage participants to follow their regimen. The final step in the intervention cascade includes directly observed therapy. Outcome measures include CD4, CD8, viral load, reduction in self-reported risk behaviors, and cost effectiveness ratios. Preliminary data on process and outcomes will be presented.

Learning Objectives: At the conclusion of the session, the learner will be able to

Keywords: Adherence, HIV Interventions

Related Web page: cmhpsr.med.upenn.edu/mblank/nursing.html

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

[ Recorded presentation ] Recorded presentation

Mental Illness and Chronic Medical Conditions

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA