Assessing the STIRR model of best practices for blood-borne infections of clients with severe mental illness.
OBJECTIVE
People with co-occurring severe mental illness and a substance use disorder are at markedly elevated risk of infection from HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), but they generally do not receive basic recommended screening or preventive and treatment services. Barriers to services include lack of programs offered by mental health providers and client refusal of available services. Clients from racial-ethnic minority groups are even less likely to accept recommended services. The intervention tested was designed to facilitate integrated infectious disease programming in mental health settings and to increase acceptance of such services among clients.


METHODS
A randomized controlled trial (N=236) compared enhanced treatment as usual (control) with a brief intervention to deliver best-practice services for blood-borne diseases in an urban sample of clients with co-occurring disorders who were largely from racial-ethnic minority groups. The "STIRR" intervention included Screening for HIV and HCV risk factors, Testing for HIV and hepatitis, Immunization against hepatitis A and B, Risk reduction counseling, and medical treatment Referral and support at the site of mental health care.


RESULTS
Clients randomly assigned to the STIRR intervention had high levels (over 80%) of participation and acceptance of core services. They were more likely to be tested for HBV and HCV, to be immunized against hepatitis A virus and HBV, and to increase their knowledge about hepatitis and reduce their substance abuse. However, they showed no reduction in risk behavior, were no more likely to be referred to care, and showed no increase in HIV knowledge. Intervention costs were $541 per client (including $234 for blood tests).


CONCLUSIONS
STIRR appears to be efficacious in providing a basic, best-practice package of interventions for clients with co-occurring disorders.
Rosenberg
Stanley D
SD
Departments of Psychiatry and of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH 03756, USA. stanley.rosenberg@dartmouth.edu
Goldberg
Richard W
RW
Dixon
Lisa B
LB
Wolford
George L
GL
Slade
Eric P
EP
Himelhoch
Seth
S
Gallucci
Gerard
G
Potts
Wendy
W
Tapscott
Stephanie
S
Welsh
Christopher J
CJ
D000328:Adult; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D019317:Evidence-Based Medicine; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis; D006526:Hepatitis C / Q000175:diagnosis; D006801:Humans; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders; D008875:Middle Aged; D008962:Models, Theoretical; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation; D012720:Severity of Illness Index; D014505:Urban Population
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