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

• Autor(a) principal: Wainberg,Milton L.
• Data de Publicação: 2020
• Outros Autores: 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
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Brazilian Journal of Psychiatry (São Paulo. 1999. Online)
• Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462020000400007
• topic: Prevention; intervention study; behavioral research; treatment efficacy; program effectiveness

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