Modified therapeutic community aftercare for clients triply diagnosed with HIV/AIDS and co-occurring mental and substance use disorders

Abstract

This clinical trial evaluated a modified therapeutic community aftercare (MTC-A) program for a population triply diagnosed with HIV/AIDS, a substance use disorder, and a mental disorder. After six months of MTC residential treatment (MTC-R), subjects were randomly assigned to MTC-A (n=42) or to standard aftercare (C; n=34). Follow-up interviews at six and 12 months assessed eight outcome domains and adherence to prescribed HIV medication. A propensity model was used to re-balance the retrieved sample. At the six-month follow-up, High stratum MTC-A clients (those with greater psychological functioning and stable physical health at baseline) had greater improvement overall and for substance use and mental health than C clients in the same stratum. In contrast, C clients in the Low/Medium stratum (those with poorer psychological functioning and improved physical health) had more favorable outcomes overall and for substance use than their MTC-A counterparts; however, this stratum was not re-balanced effectively. Differences in HIV medication adherence were not detected. Clients with greater psychological functioning and stable health at treatment entry benefit more from the MTC-A program. In view of the potentially progressive nature of HIV, measuring physical and mental health during treatment and controlling for changes could be important in future research.

Keywords:

• HIV
• AIDS
• co-occurring disorders
• modified therapeutic community
• aftercare
• triply diagnosed population
• clinical trial

Acknowledgements

This article has not been published elsewhere nor has it been submitted simultaneously for publication elsewhere.

The work reported in this manuscript was supported by a grant 1 UD1-SM52403, Integrated Residential/Aftercare TC for HIV/AIDS and Comorbid Disorders, Center for Mental Health Services (CMHS) with Health Resources & Services Administration (HRSA) HIV/AIDS Bureau, National Institutes of Health (NIH), National Institute of Mental Health (NIMH), National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse & Alcoholism (NIAAA), GFA No. SM 98.007, FCFDA No. 93.230, Cooperative Agreements for an HIV/AIDS Treatment Adherence, Health Outcomes, and Cost Study.Views and opinions are those of the authors and do not necessarily reflect those of the Department of Health & Human Services, SAMHSA, CMHS, or HRSA, HIV/AIDS Bureau, or the National Institutes of Health, NIDA, NIMH, and NIAAA.