HIV Prevention for Mentally Ill Substance Users

Carmen Masson, UC San Francisco

Persons with co-occurring severe mental illness (SMI) and substance use disorders are at especially high risk for HIV and other blood borne diseases. They also tend to be high utilizers of emergency department and inpatient medical services. Moreover, HIV contributes substantially to morbidity and mortality among those with co-occurring disorders. These persons face significant barriers to accessing health care, including HIV prevention services. Case management is the dominant approach for addressing the special needs of this group and can be used as a platform to deliver HIV prevention services. Prevention case management combines individual-level HIV risk reduction interventions with traditional case management, however, little research has examined the effect of prevention case management on HIV risk transmission behaviors. This gap is even more acute for intervention studies with persons who have co-occurring disorders. Effective HIV prevention case management models for SMI groups may have the potential to reduce the spread of HIV, improve health-related quality of life, and reduce the costs of treating preventable diseases.

This pilot study develops and tests the effectiveness of an innovative HIV prevention case management model in a sample of out-of-treatment substance users with co-occurring psychiatric disorders, a group that has historically been difficult to engage in HIV prevention efforts. The specific aims of this pilot study are to: 1) develop a manual-guided HIV prevention case management intervention for substance users with SMI; 2) develop a case manager training, supervision, and quality assurance protocol; and 3) test two hypotheses regarding the impact of the manual-guided HIV prevention case management intervention on HIV and hepatitis knowledge and risk behaviors. We will compare case management combined with an enhanced cognitive-behavioral intervention to case management with standard HIV education and counseling (including information on hepatitis B and C transmission risk behaviors). The standard intervention adheres to the Centers for Disease Control guidelines for HIV education, counseling, testing, and referral. It is hypothesized that those assigned to the enhanced condition will demonstrate greater reductions in HIV transmission risk behaviors than those in the standard condition. It is also hypothesized that those in the enhanced condition will show greater increases in knowledge of HIV and hepatitis B and C transmission risk behaviors. Participants will be recruited from an urban public hospital and randomly assigned to the enhanced or standard case management conditions. Assessments will occur at baseline, and at 3, 6, and 9 months from the date of randomization. The long-term objective of this pilot work is to provide data that will be essential to support the submission of an exploratory/development research grant. Innovative HIV prevention interventions targeted at SMI populations may have the potential to reduce future public health care costs.