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研究向实践转化科学面临的挑战与机遇:一项针对公立精神卫生系统精神科患者的性行为风险降低干预的随机对照试验得出的经验教训

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.

机构信息

Columbia University, New York, NY, USA.

Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

出版信息

Braz J Psychiatry. 2020 Aug;42(4):349-359. doi: 10.1590/1516-4446-2019-0737. Epub 2020 Jan 24.

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.

摘要

目的

在资源丰富的国家的研究环境中,已经对精神科患者进行了人类免疫缺陷病毒(HIV)预防功效试验,证明了短期减少性风险行为的功效。但是,在护理系统中尚未实施这些试验。在过去的十年中,克服这一从研究到实践的差距已成为实施科学的重点。本文描述了在经过培训的诊所提供人员的协助下,在真实的门诊精神科环境中进行的第一个也是唯一一个针对精神科患者的 HIV 预防干预试验。

方法

该 HIV 预防干预措施使用信息-动机-行为技能模型来实现降低性风险的目标,已严格适应当地环境和诊所服务的需求。来自八个诊所的参与者被随机分配到 HIV 预防或健康促进条件组。

结果

HIV 预防组在信息-动机-行为领域有显著改善;在该组中,行为意图与无保护性行为次数明显减少相关,但在两种条件下,无保护性行为次数的减少是相似的。

结论

我们的试验是在实施研究获得广泛资助之前进行的。将干预措施转移到新的文化或实际实践环境中可能需要进行调整。我们的结果表明,需要明确的指导方针,以确定是否进行功效、效果和/或实施研究作为最合适的下一步。

临床试验注册

NCT00881699。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3142/7430387/a6bac1bdc683/bjp-42-04-349-g001.jpg

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