title: Modified therapeutic community aftercare for clients triply diagnosed with HIV/AIDS and co-occurring mental and substance use disorders.
abstract: This clinical trial evaluated a modified therapeutic community aftercare (MTC-A) program for a population triply diagnosed with HIV/AIDS, a substance use disorder, and a mental disorder. After six months of MTC residential treatment (MTC-R), subjects were randomly assigned to MTC-A (n=42) or to standard aftercare (C; n=34). Follow-up interviews at six and 12 months assessed eight outcome domains and adherence to prescribed HIV medication. A propensity model was used to re-balance the retrieved sample. At the six-month follow-up, High stratum MTC-A clients (those with greater psychological functioning and stable physical health at baseline) had greater improvement overall and for substance use and mental health than C clients in the same stratum. In contrast, C clients in the Low/Medium stratum (those with poorer psychological functioning and improved physical health) had more favorable outcomes overall and for substance use than their MTC-A counterparts; however, this stratum was not re-balanced effectively. Differences in HIV medication adherence were not detected. Clients with greater psychological functioning and stable health at treatment entry benefit more from the MTC-A program. In view of the potentially progressive nature of HIV, measuring physical and mental health during treatment and controlling for changes could be important in future research.
authors.affiliation: Center for the Integration of Research & Practice (CIRP), National Development & Research Institutes, Inc. (NDRI), New York, USA. stansacks@mac.com
authors.forename: Stanley
authors.initials: S
authors.lastname: Sacks
authors.forename: Karen
authors.initials: K
authors.lastname: McKendrick
authors.forename: Peter
authors.initials: P
authors.lastname: Vazan
authors.forename: Joann Y
authors.initials: JY
authors.lastname: Sacks
authors.forename: Charles M
authors.initials: CM
authors.lastname: Cleland
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000628:therapy; D000328:Adult; D000359:Aftercare / Q000592:standards*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D001523:Mental Disorders / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D015397:Program Evaluation; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*; D013808:Therapeutic Community; D016896:Treatment Outcome; D055815:Young Adult