Challenges and opportunities in the science of research to practice: lessons learned from a randomized controlled trial of a sexual risk-reduction intervention for psychiatric patients in a public mental health system

Objective: Human immunodeficiency virus (HIV) prevention efficacy trials with psychiatric patients have been conducted in research settings in high-resourced countries, establishing short-term efficacy for reducing sexual risk behavior. None has been implemented within systems of care. In the last decade, overcoming this research-to-practice gap has become a focus of implementation science. This paper describes the first and only HIV Prevention intervention trial for psychiatric patients conducted in real-world outpatient psychiatric settings facilitated by trained clinic-based providers. Methods: The HIV Prevention intervention, which uses the Information-Motivation-Behavioral Skills model to achieve sexual risk-reduction, was rigorously adapted to the local context and clinic services' needs. Participants from eight clinics were randomized to HIV Prevention or Health Promotion conditions. Results: HIV Prevention participants showed significant improvement in Information-Motivation-Behavioral domains; in this group, behavioral intentions were associated with significantly fewer unprotected sex occasions, but reduction of unprotected sex occasions was similar in both conditions. Conclusion: Our trial was conducted before implementation studies became widely funded. Transporting an intervention to a new culture or into real-world practice settings may require adaptations. Our results demonstrate that clear guidelines are needed regarding whether to conduct efficacy, effectiveness, and/or implementation research as the most appropriate next step. Clinical trial registration: NCT00881699

Infecção pelo HIV entre gestantes atendidas nos centros de testagem e aconselhamento em Aids / HIV infection among pregnant women attended in testing and counseling centers for AIDS / HIV infection among pregnant women attended in testing and counseling centers for AIDS

OBJETIVO: Estimar a prevalência do HIV e identificar comportamentos sexuais de risco para a infecção em gestantes que realizaram rotina da assistência pré-natal. MÉTODOS: Estudo transversal com base em registros de atendimentos de 8.002 gestantes (25 por cento do total dos municípios) residentes em 27 municípios da Região Sul do Brasil, em 2003, que realizaram testes anti-HIV em Centro de Testagem e Aconselhamento que realizavam pré-natal. Foram coletadas informações sociodemográficas e comportamentais, além dos resultados de testes para sífilis e HIV, nas consultas de aconselhamento individual registradas em banco de dados do Sistema de Informações dos Centros de Testagem e Aconselhamento. Foram excluídas da base de dados as gestantes que buscaram os Centros para confirmação de sorologia anterior e aquelas encaminhadas ao serviço por apresentarem sintomas de Aids. RESULTADOS: Do total de gestantes estudadas, 0,5 por cento (IC 95 por cento=0,3-0,6) foram positivas para o HIV. A única variável associada com a soropositividade para o HIV foi o nível de escolaridade. A maioria das gestantes se expôs basicamente por meio de relações sexuais sem preservativos com o parceiro único com quem mantinham relação estável. As gestantes mais jovens, solteiras, desempregadas e de menor escolaridade constituíram o grupo de maior exposição. CONCLUSÕES: O Sistema de Informações dos Centros de Testagem e Aconselhamento revelou-se útil à vigilância epidemiológica da infecção pelo HIV e dos comportamentos de risco no segmento de gestantes e pode vir a sê-lo em relação a outras populações.

OBJECTIVE: To estimate HIV prevalence and identify high-risk sexual behavior for infection in pregnant women who were given prenatal assistance. METHODS: Cross-sectional study based on attendance records of 8,002 pregnant women (25 percent of all municipalities) who lived in 27 municipalities in Southern Brazil in 2003 and had anti-HIV tests done in a testing and counseling center that performed prenatal assistance. Sociodemographic and behavioral data were gathered, as well as syphilis and HIV test results, during the individual counseling sessions registered in the data bank of the Sistema de Informações dos Centros de Testagem e Aconselhamento (Information System on Testing and Counseling Centers). Women who sought the centers for confirmation of previous serology or were referred to this service due to the presence of AIDS symptoms were excluded from the data base. RESULTS: A total of 0.5 percent of all the pregnant women analyzed (CI 95 percent=0.3;0.6) were HIV positive. The only variable associated with HIV seropositivity was schooling. The majority of them were basically exposed through unprotected sexual intercourse with the only partner they had a steady relationship with. Younger pregnant women who were single, unemployed and had lower level of education constituted the group with highest exposure. CONCLUSIONS: The Sistema de Informações dos Centros de Testagem e Aconselhamento turned out to be useful for the epidemiological surveillance of HIV infection and high-risk behavior among pregnant women and could also be useful as regards other populations.