Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #102382

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

• articluate how to titrate a preventive intervention for regimen adherence using the intervention cascade approach
• describe how the intevention casecade is being used to improve adherence to HIV regimen among persons with mental illness
• apply the intervention cascade approach to prevention in other areas of health and mental health care

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