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The NIMH Healthy Living Project

The NIMH Healthy Living Project. Rotheram-Borus MJ, Kelly JA, Ehrhardt AA, Chesney MA, Lightfoot M, Weinhardt LS, Kirshenbaum SB, Johnson MO, Remien RH, Morin SF, Kertzner RM, Pequegnat W, Gordon CM, and the NIMH Healthy Living Project Team . Acknowledgements.

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The NIMH Healthy Living Project

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  1. The NIMH Healthy Living Project Rotheram-Borus MJ, Kelly JA, Ehrhardt AA, Chesney MA, Lightfoot M, Weinhardt LS, Kirshenbaum SB, Johnson MO, Remien RH, Morin SF, Kertzner RM, Pequegnat W, Gordon CM, and the NIMH Healthy Living Project Team

  2. Acknowledgements • National Institute of Mental Health grants U10-MH57636, U10- MH57631, U10-MH57616, and U10‑MH57615. • NIMH center grants: • P30-MH058107 (Mary Jane Rotheram-Borus, Ph.D., PI) • P30-MH57226 (Jeffrey A. Kelly, Ph.D., PI) • P50-MH043520 (Anke A. Ehrhardt, Ph.D., PI) • P30-MH062246 (Thomas J. Coates, Ph.D., PI) • Ellen Stover, Ph.D, Willo Pequegnat, Ph.D., Christopher M. Gordon, Ph.D., and Dianne Rausch, Ph.D.

  3. NIMH Healthy Living Project • Goals of Study • Intervention • Describe Sample

  4. Primary Goal • Transmission Acts

  5. Secondary Goals • Adherence • Mental Health

  6. Design • Four-Cities • MSM, Women, IDU, Heterosexual Men • Qualitative, formative phase • Randomized intervention trial

  7. Design Baseline (n = 3819) Eligible 28% Randomized (n = 936) Lagged Control (n = 451) Immediate Intervention (n = 446)

  8. Healthy Living Project Recruit Months Assessment ImmediateIntervention Randomize Lagged Condition 0 T1 Module 1:Stress, Coping, & Adjustment 5 T2 Module 2:Risk Behaviors 10 T3 Module 3:Health Behaviors 15 T4 20 T5 25 T6 1: Stress, Coping, & Adjustment 2: Risk Behaviors 3: Health Behaviors

  9. Social Action Theory

  10. Intervention Sessions • 90 minutes • Individual • Interactive • Discussion of Goals • Content / activities • Appraisal / meaning • Skills building • Goal setting / problem solving

  11. Module 1Stress and Coping • 1 Assessment: Life context • 2 Stress and Coping I • 3 Stress and Coping II • 4 Social Support • 5 Maintaining Adaptive Coping C.E.T.

  12. Module 2HIV Transmission Risk Behavior • 1 HIV-Related Knowledge • 2 Safer Behavior • 3 Communication Skills • 4 Disclosure Decisions • 5 Maintaining Safer Behavior

  13. Module 3 Medical Adherence / Healthy Lifestyle • 1 Current Health Behaviors • 2 Assertive Communication • 3 Social Support and Adherence • 4 Staying on Track • 5 Future Choices

  14. Baseline Sample • N = 3,819 • Recruited from clinics and community venues (recruitment tailored to city)

  15. Sample Characteristics

  16. Ethnicity

  17. HIV Transmission Risk Behavior • > 75% sexually active • 28% TRB Eligibility Criteria • MSM more likely to have multiple partners, but not to engage in TRB • 18% of IDU shared needles

  18. Medication Adherence = 90% • 75% on ART • 35% non-adherent with ART • Predictors of non-adherence • African American • Homelessness or IDU • Primary relationship • Medication ‘fatigue’ • Predictors of better adherence • Self-efficacy • Fit with daily routines • Connection between adherence and virus strength

  19. Current Status • Completion in spring of 2004 • Outcome analyses will follow

  20. Challenges • Delivery modality • Staff training and commitment • Intervention integrity • Number of sessions • Life course delivery

  21. Advantages • Anticipate high uptake given current adherence • Consistent with CDC recommendations • Relevant to clinical case management • Allow for delivery in medical settings • Targets those most at-risk for transmission

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