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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
Wainberg, Milton L.; Mann, Claudio G.; Norcini-Pala, Andrea; McKinnon, Karen; Pinto, Diana; Pinho, Veronica; Cavalcanti, Maria T.; Cheng-Shiun, Leu; Guimarães, Mark D.; Mattos, Paulo; Hughes, Elizabeth; Palinkas, Lawrence A.; Otto-Salaj, Laura; Remien, Robert H.; Cournos, Francine.
  • Wainberg, Milton L.; Columbia University. New York. US
  • Mann, Claudio G.; Universidade Federal do Rio de Janeiro (UFRJ). Rio de Janeiro. BR
  • Norcini-Pala, Andrea; Columbia University. New York. US
  • McKinnon, Karen; Columbia University. New York. US
  • Pinto, Diana; Universidade Federal do Estado do Rio de Janeiro (UNIRIO). Rio de Janeiro. BR
  • Pinho, Veronica; George Washington University. Washington. US
  • Cavalcanti, Maria T.; Universidade Federal do Rio de Janeiro (UFRJ). Rio de Janeiro. BR
  • Cheng-Shiun, Leu; Columbia University. New York. US
  • Guimarães, Mark D.; Universidade Federal de Minas Gerais (UFMG). Belo Horizonte. BR
  • Mattos, Paulo; Universidade Federal do Rio de Janeiro (UFRJ). Rio de Janeiro. BR
  • Hughes, Elizabeth; University of Leeds. Leeds. GB
  • Palinkas, Lawrence A.; University of Southern California. Los Angeles. US
  • Otto-Salaj, Laura; University of Wisconsin-Milwaukee. Milwaukee. US
  • Remien, Robert H.; Columbia University. New York. US
  • Cournos, Francine; Columbia University. New York. US
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 42(4): 349-359, July-Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1132089
ABSTRACT

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
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Sexual Behavior / HIV Infections / Randomized Controlled Trials as Topic / Mental Health / Community Mental Health Services / Mentally Ill Persons / Risk Reduction Behavior Type of study: Controlled clinical trial / Etiology study / Practice guideline / Risk factors Limits: Female / Humans / Male Language: English Journal: Braz. J. Psychiatry (São Paulo, 1999, Impr.) Journal subject: Psychiatry Year: 2020 Type: Article Affiliation country: Brazil / United States / United kingdom Institution/Affiliation country: Columbia University/US / George Washington University/US / Universidade Federal de Minas Gerais (UFMG)/BR / Universidade Federal do Estado do Rio de Janeiro (UNIRIO)/BR / Universidade Federal do Rio de Janeiro (UFRJ)/BR / University of Leeds/GB / University of Southern California/US / University of Wisconsin-Milwaukee/US

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Full text: Available Index: LILACS (Americas) Main subject: Sexual Behavior / HIV Infections / Randomized Controlled Trials as Topic / Mental Health / Community Mental Health Services / Mentally Ill Persons / Risk Reduction Behavior Type of study: Controlled clinical trial / Etiology study / Practice guideline / Risk factors Limits: Female / Humans / Male Language: English Journal: Braz. J. Psychiatry (São Paulo, 1999, Impr.) Journal subject: Psychiatry Year: 2020 Type: Article Affiliation country: Brazil / United States / United kingdom Institution/Affiliation country: Columbia University/US / George Washington University/US / Universidade Federal de Minas Gerais (UFMG)/BR / Universidade Federal do Estado do Rio de Janeiro (UNIRIO)/BR / Universidade Federal do Rio de Janeiro (UFRJ)/BR / University of Leeds/GB / University of Southern California/US / University of Wisconsin-Milwaukee/US