Principal Investigator: Paul Colson, Ph.D, (Charles P. Felton National Tuberculosis Center at Harlem Hospital); Co-Principal Investigators: Sharon Mannheimer, M.D. and Wafaa El-Sadr, M.D., M.P.H. (Harlem Hospital); D.A. Johnson, (NYC OMH Office of Recipient Affairs); Judith Samuels, Ph.D., (NKI).
| Adherence
to antiretroviral medication regimens has become increasingly
important in managing HIV infection. These potent therapies require that
patients take multiple pills, each with specific instructions,
resulting in very demanding and complex schedules. Their life-saving
potential can be lost rapidly if the treatments are not taken properly
and drug resistance develops. In this study, a peer worker who also has
HIV will provide support to PSMD with HIV, with the perspective of PSMD
peers incorporated into their training. Physicians, mental health
service recipients and a consumer will enhance the ability of PSMD to
access effective treatment for HIV in a multi-cultural community.
The investigators have extensive
experience in research on HIV among PSMD who are homeless. Dr. Colson
was co-investigator in a study of HIV sex and drug taking risk behaviors
among homeless men with SMD, and in the design of a risk reduction
intervention for homeless women. Drs. Mannheimer and El-Sadr have also
been part of a nationwide study on adherence factors in AIDS treatment,
and in programs at Harlem Hospital targeting persons with HIV and
tuberculosis. |
This project will:
1) identify factors that relate to treatment adherence for HIV antiretroviral medications among PSMD, and adapt instruments to measure these factors;
2) implement a model intervention for PSMD with HIV, incorporating peer support and based on the Transtheoretical Model of Change theory in a small sample and qualitatively assess client satisfaction; and
3)
test our ability to collect data over time on adherence factors, adherence,
and HIV outcomes among PSMD with HIV.
RESEARCH ACTIVITIES AND RESULTS
Methods: Focus groups and individual semi-structured interviews with PSMD and their providers were conducted in order to identify factors that might relate to treatment adherence. Based on these results we will develop a structured adherence factor instrument based on items -- where possible -- drawn from existing instruments. Peer workers were trained in the conduct of the intervention, including training from PSMD consumers with experience in providing peer services to PSMD.
Results:
Results
from the exploratory phase of this project, involving open-ended interviews with
PSMD with HIV, which was completed last year were presented at the 2001 Annual
Meeting of the American Public Health Association.
Ms. D.A. Johnson of the Office of Recipient Affairs, NYS Office of Mental
Health, met with Harlem Adherence to Treatment Study (HATS)
investigators and staff to discuss program design and to plan training
activities for the mental health component. In collaboration with the Department
of Psychiatry, patients with HIV were referred for participation the HATS
randomized clinical trial testing a peer model to improve adherence to
antiretroviral medications. These individuals were placed directly into the
experimental arm of the HATS so as to receive the peer intervention.
An abstract comparing those with mental illness to others in the HATS
dataset was submitted to the 2002 International AIDS Conference.
Full IRB approval was obtained in December 2001, after delays related to
September 11th and other issues.
SIGNIFICANCE OF FINDINGS/ POLICY IMPLICATIONS
Incidence of HIV among PSMD, particularly among African Americans, is high. Mental health problems may interfere with an individual’s ability and motivation to follow treatment regimens as HIV regimens are demanding, especially in conjunction with psychotropic regimens. Finding methods to encourage adherence to these treatment plans should translate into far better outcomes for PSMD with HIV.
PLANS
Over the next few months, approximately 15
PSMD with HIV will be enrolled in HATS
which has enrolled 180 participants to date.
PSMD enrollees will receive the experimental intervention, which employs
HIV+ peers to provide peer support using the TMC.
This project will adapt the HATS intervention to include more
substantial, PSMD peer driven training on mental health issues for PSMD.
INCLUSION
OF GENDER AND MINORITY SUBJECTS
|
|
Amer Indian, Alaska Native |
Asian, Pacific Islander |
Black, not Hispanic |
Hispanic |
White, not Hispanic |
Unknown Origin |
TOTAL |
|
Female |
|
|
4 |
1 |
1 |
|
6 |
|
Male |
|
|
7 |
1 |
|
|
8 |
|
Unknown |
|
|
|
|
|
|
|
|
TOTAL |
|
|
11 |
2 |
1 |
|
14 |
Entered: July 2000
Updated: June 17, 2002
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