The NIMH Healthy Living Project

Rotheram-Borus MJ, Kelly JA, Ehrhardt AA, Chesney MA, Rotheram-Borus MJ, Kelly JA, Ehrhardt AA, Chesney MA, Lightfoot M, Weinhardt LS, Kirshenbaum SB, Johnson MO, Lightfoot M, Weinhardt LS, Kirshenbaum SB, Johnson MO,

Remien RH, Morin SF, Kertzner RM, Pequegnat W, Gordon CM, Remien RH, Morin SF, Kertzner RM, Pequegnat W, Gordon CM, and the NIMH Healthy Living Project Team and the NIMH Healthy Living Project Team

AcknowledgementsAcknowledgementsNational Institute of Mental Health grants U10-National Institute of Mental Health grants U10-MH57636, U10- MH57631, U10-MH57616, and MH57636, U10- MH57631, U10-MH57616, and U10‑MH57615. U10‑MH57615. NIMH center grants:NIMH center grants: P30-MH058107 (Mary Jane Rotheram-Borus, Ph.D., PI) P30-MH058107 (Mary Jane Rotheram-Borus, Ph.D., PI) P30-MH57226 (Jeffrey A. Kelly, Ph.D., PI)P30-MH57226 (Jeffrey A. Kelly, Ph.D., PI) P50-MH043520 (Anke A. Ehrhardt, Ph.D., PI)P50-MH043520 (Anke A. Ehrhardt, Ph.D., PI) P30-MH062246 (Thomas J. Coates, Ph.D., PI)P30-MH062246 (Thomas J. Coates, Ph.D., PI)

Ellen Stover, Ph.D, Willo Pequegnat, Ph.D., Ellen Stover, Ph.D, Willo Pequegnat, Ph.D., Christopher M. Gordon, Ph.D., and Dianne Rausch, Christopher M. Gordon, Ph.D., and Dianne Rausch, Ph.D.Ph.D.

NIMH Healthy Living ProjectNIMH Healthy Living Project

Goals of StudyGoals of Study

InterventionIntervention

Describe SampleDescribe Sample

Primary GoalPrimary Goal

Transmission ActsTransmission Acts

Secondary GoalsSecondary Goals

AdherenceAdherence

Mental HealthMental Health

DesignDesign

Four-CitiesFour-Cities

MSM, Women, IDU, Heterosexual MenMSM, Women, IDU, Heterosexual Men

Qualitative, formative phaseQualitative, formative phase

Randomized intervention trialRandomized intervention trial

Immediate Intervention(n = 446)

Lagged Control(n = 451)

Baseline(n = 3819)

Randomized(n = 936)

DesignDesign

Eligible28%

Recruit

RandomizeImmediateIntervention

Lagged Condition

Module 1:Stress, Coping, &

Adjustment

Module 2:

Risk Behaviors

Module 3:

Health Behaviors

Months Assessment

0 T1

5 T2

10 T3

15 T4

20 T5

25 T61: Stress, Coping, & Adjustment

2: Risk Behaviors

3: Health Behaviors

Healthy Living ProjectHealthy Living Project

Social Action TheorySocial Action Theory

Intervention SessionsIntervention Sessions

90 minutes90 minutes

IndividualIndividual

InteractiveInteractive

Discussion of GoalsDiscussion of Goals

Content / activitiesContent / activities Appraisal / meaningAppraisal / meaning Skills buildingSkills building

Goal setting / problem solvingGoal setting / problem solving

Module 1Module 1Stress and CopingStress and Coping

1 1 Assessment: Life contextAssessment: Life context

2 2 Stress and Coping IStress and Coping I

3 Stress and Coping II3 Stress and Coping II

4 Social Support 4 Social Support

5 Maintaining Adaptive Coping5 Maintaining Adaptive Coping

C.E.T.

Module 2Module 2HIV Transmission Risk BehaviorHIV Transmission Risk Behavior

1 1 HIV-Related KnowledgeHIV-Related Knowledge

22 Safer BehaviorSafer Behavior

33 Communication SkillsCommunication Skills

44 Disclosure DecisionsDisclosure Decisions

55 Maintaining Safer BehaviorMaintaining Safer Behavior

11 Current Health BehaviorsCurrent Health Behaviors

22 Assertive CommunicationAssertive Communication

33 Social Support and AdherenceSocial Support and Adherence

44 Staying on TrackStaying on Track

55 Future ChoicesFuture Choices

Module 3 Module 3 Medical Adherence / Healthy LifestyleMedical Adherence / Healthy Lifestyle

Baseline SampleBaseline Sample

N = 3,819N = 3,819

Recruited from clinics and Recruited from clinics and community venues community venues (recruitment tailored to (recruitment tailored to city)city)

Sample CharacteristicsSample Characteristics

56%

21%

12%

11%

MSM

Women

IDU

HTM

EthnicityEthnicity

45%

15%

32%

8%

AfricanAmerican

Hispanic

White

Other

HIV Transmission Risk BehaviorHIV Transmission Risk Behavior

> 75% sexually active> 75% sexually active

28% TRB Eligibility Criteria28% TRB Eligibility Criteria

MSM more likely to have multiple partners, but MSM more likely to have multiple partners, but not to engage in TRBnot to engage in TRB

18% of IDU shared needles18% of IDU shared needles

Medication Adherence = 90%Medication Adherence = 90%

75% on ART75% on ART35% non-adherent with ART35% non-adherent with ARTPredictors of non-adherencePredictors of non-adherence African AmericanAfrican American Homelessness or IDUHomelessness or IDU Primary relationshipPrimary relationship Medication ‘fatigue’Medication ‘fatigue’

Predictors of better adherencePredictors of better adherence Self-efficacySelf-efficacy Fit with daily routinesFit with daily routines Connection between adherence and virus strengthConnection between adherence and virus strength

Current StatusCurrent Status

Completion in spring of 2004Completion in spring of 2004

Outcome analyses will followOutcome analyses will follow

ChallengesChallenges

Delivery modalityDelivery modality

Staff training and commitmentStaff training and commitment

Intervention integrityIntervention integrity

Number of sessionsNumber of sessions

Life course deliveryLife course delivery

AdvantagesAdvantages

Anticipate high uptake given current Anticipate high uptake given current adherenceadherence

Consistent with CDC recommendationsConsistent with CDC recommendations

Relevant to clinical case managementRelevant to clinical case management

Allow for delivery in medical settingsAllow for delivery in medical settings

Targets those most at-risk for transmissionTargets those most at-risk for transmission