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 Academic Article uri icon

abstract

  • 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.

authors

  • Wainberg, Milton L
  • 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

publication date

  • 2020