A randomized trial of a nursing intervention for HIV disease management among persons with serious mental illness.
OBJECTIVE
The heightened risk of persons with serious mental illness to contract and transmit HIV is recognized as a public health problem. Persons with HIV and mental illness may be at risk for poor treatment adherence, development of treatment-resistant virus, and worse outcomes. The objective of this study was to test the effectiveness of a community-based advanced practice nurse (APN) intervention (PATH, Preventing AIDS Through Health) to promote adherence to HIV and psychiatric treatment regimens.


METHODS
Community-dwelling HIV-positive participants with co-occurring serious mental illnesses (N=238) were recruited from community HIV provider agencies from 2004 to 2008 to participate in the randomized controlled trial. Participants in the intervention group (N=128) were assigned an APN who provided community-based care management at a minimum of one visit per week and coordinated clients' medical and mental health care for one year. Viral load and CD4 cell count were evaluated at baseline and 12 months.


RESULTS
Longitudinal models for continuous log viral load showed that compared with the control group, the intervention group exhibited a significantly greater reduction in log viral load at 12 months (d=-.361 log 10 copies per milliliter, p<.001). Differences in CD4 counts from baseline to 12 months were not statistically significant.


CONCLUSIONS
This project demonstrated the effectiveness of community-based APNs in delivering a tailored intervention to improve outcomes of individuals with HIV and co-occurring serious mental illnesses. Persons with these co-occurring conditions can be successfully treated; with appropriate supportive services, their viral loads can be reduced.
Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104-3309, USA. mblank2@mail.med.upenn.edu
Michael B
MB
Blank
Nancy P
NP
Hanrahan
Martin
M
Fishbein
Evan S
ES
Wu
Julie A
JA
Tennille
Thomas R
TR
Ten Have
Ann M
AM
Kutney-Lee
Robert
R
Gross
Janet M
JM
Hines
James C
JC
Coyne
Linda H
LH
Aiken
D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000451:nursing*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D057194:Intention to Treat Analysis; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000188:drug therapy / Q000451:nursing*; D009722:Nurse Practitioners; D015397:Program Evaluation; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012648:Self Care; D016896:Treatment Outcome; D019562:Viral Load; D016903:Drug Monitoring
D011619:Psychotropic Drugs