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

Milton L. Wainberg*, Claudio G. Mann, Andrea Norcini-Pala, Karen McKinnon, Diana Pinto, Veronica Pinho, Maria T. Cavalcanti, Leu Cheng-Shiun, Mark D. Guimarães, Paulo Mattos, Elizabeth Hughes, Lawrence A. Palinkas, Laura Otto-Salaj, Robert H. Remien, Francine Cournos, PRISSMA Project

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
19 Downloads (Pure)

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.

Original languageEnglish
Pages (from-to)349-359
Number of pages11
JournalBrazilian Journal of Psychiatry
Volume42
Issue number4
Early online date24 Jan 2020
DOIs
Publication statusPublished - Aug 2020
Externally publishedYes

Keywords

  • Behavioral research
  • Intervention study
  • Prevention
  • Program effectiveness
  • Treatment efficacy

ASJC Scopus subject areas

  • Psychiatry and Mental health

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