CLINICAL DIRECTORS NETWORK, INC.

UNIVERSITY OF MIAMI

SMART/EST Women Project III

This three year project, funded by the Centers for Disease Control proposes to evaluate the feasibility of disseminating an effective behavioral intervention for HIV+ women seen in Community Health Centers via a staged technology transfer process.  The process will include providing training, clinician professional development and clinical supervision, quality assurance, evaluation and technical support to integrate the health behavior strategies into an established system of primary care, resulting in a sustainable, comprehensive and effective primary and behavioral health care delivery system. This multi-site, randomized translational study will include a total of  4 Community Health Centers from New York, New Jersey and Florida. A total of 384 HIV+ women will be enrolled and followed for this study.

The two main components of the intervention include enhanced cognitive behavioral stress management/expressive supportive therapy  (CBSM+) and Group Healthy Lifestyles (GHL), a health promotion program designed by the research team for women living with HIV. The 10 week CBSM+ component of the intervention includes a series of exercises designed to provide information on stress responses and coping, teach anxiety reduction skills, modify maladaptive cognitive appraisals using cognitive restructuring and reframing strategies, enhance interpersonal conflict resolution skills and anger management via negotiation skills training, encourage participants to use active, problem-solving, coping strategies rather than passive, emotion-based coping, provide a supportive group environment for the open expression of feelings and thoughts, increase utilization of social support networks, as well as appropriate health care  and community resources, increase knowledge, change attitudes and improve adherence to the healthy living components. The  6  week GHL components represent detailed goal-based curricula to support CHCs already using the Chronic Care Model by establishing and monitoring patient self-management goals, which includes behavioral strategies to improve medication adherence, safer sex, nutrition, alcohol, smoking and substance use, and physical activity.

The long-term goal of this project is to refine the intervention and to develop a standardized protocol that can be integrated into the usual care procedures of the C/MHCs, thereby maximizing the likelihood that the intervention will be implemented, adopted and sustained at each of the participating Community Health Centers.