Background
Methods
Data sources and searches
Study selection
Data abstraction and assessment of methodological quality
Components | Strong | Moderate | Weak |
---|---|---|---|
Selection Bias | Very likely to be representative of the target population and participation rate >80% | Somewhat likely to pre representative of the target population and participation rate between 60 to 79% | All other responses or not stated |
Study design | Randomized controlled trial or controlled clinical trial | Cohort analytic, case control, cohort or an interrupted time series | All other designs or design not stated |
Confounders | Controlled for at least 80% of confounders | Controlled for at least 60 to 79% of confounders | Confounders not controlled for or not stated |
Blinding | Blinding of outcome assessors and study participants to intervention status and/or research question | Blinding of either outcome assessors or study participants | Outcome assessors and study participants are aware of intervention status and/or research question |
Data collection methods | Tools shown to be valid and reliable | Tools shown to be valid but reliability not described | No evidenced of validity or reliability |
Withdrawals and dropouts | Participants completing study (or follow-up rate) >80% | Participants completing study (or follow-up rate) between 60 to 79% | Participants completing study (or follow-up rate) <60% or withdrawals and dropouts not described |
Data synthesis and analysis
Results
Trial flow
Study and patient characteristics
Study, year | Setting and location | Populationa | Intervention | Control | Outcomes measured | Follow up |
---|---|---|---|---|---|---|
Homeless shelter, New York, USA | Sample size: 92 | Social skills training approach with cognitive-behavioral theory (6 sessions). Details unclear on who delivered the intervention. | Standard HIV (1 session) education (n = 42; of which 23 sexually active) | Unprotected anal, vaginal, oral sex with casual partners (women or men) as measured by VEE scorec | 6 months | |
Mean age: 38 years | ||||||
Male: 100% | ||||||
Diagnosis: Schizophrenia or schizoaffective disorder, 72%; bipolar disorder, 3%; major depressive disorder, 10% | Intervention included videos, role-playing activities for development of skills, condom use skills, negotiating safer sex, behavior change, education on risks and problem solving skills (n = 50; of which 33 sexually active) | |||||
Ethnicity: African-American, 65% | ||||||
Berkman et al. 2007,[26] | Outpatient psychiatric clinics, New York, USA | Sample size: 149 | Social skills training approach with cognitive-behavioral theory (10 sessions with boosters at 3, 6 and 9 months) delivered by substance abuse and/or mental health counsellors. | Money-management with matched treatment for dosage and format of the intervention group (n = 76) | Unprotected anal, vaginal, oral sex with casual partners (women or men) as measured by VEE scorec | 12 months |
Mean age: NR | ||||||
Male: 100% | ||||||
Diagnosis: Schizophrenia, 49%; schizoaffective disorder, 22.8%; bipolar disorder, 9.4%; major depressive disorder, 5.4% | Intervention included role-playing activities for development of skills, condom use skills, negotiating and practising safer sex (e.g. ethics, goals, commitment), behavior change, education on risks and problem solving skills (n = 73) | |||||
Ethnicity: African-American, 53.7% | ||||||
Carey et al. 2004,[28]b | Outpatient psychiatric clinics, New York, USA | Sample size: 408 | HIV risk reduction programme (10 sessions) including enhancing knowledge about HIV transmission, and prevention, motivation for behavior change and strengthening behavioral skills and self-management training (n = 142) | Standard care which included HIV and substance use education, if needed (n = 126) | Frequency of unprotected vaginal sex, total number of sex partners, total number of casual partners, number of safer sex communications before intercourse and self-report of STIs | 6 months |
Mean age: 36.5 | ||||||
Male: 46% | ||||||
Diagnosis: Schizophrenia, 18%; schizoaffective disorder, 15%; bipolar disorder, 19%; major depressive disorder, 49% | ||||||
Ethnicity: African-American, 21% | Substance use reduction programme (10 sessions) including enhancing knowledge, motivation and skills to reduce caffeine consumption, smoking, and alcohol use (n = 140) | |||||
All interventions delivered by trained clinical facilitators (with weekly supervision from a licensed clinical psychologist). | ||||||
Collins et al. 2011, [29] | Urban community setting, New York, USA | Sample size: 79 | HIV prevention programme with social cognitive theory (10 sessions) delivered by trained facilitators (no further details provided). | Money-management (10 session workshop on managing finances and last through the month) (n = 40) | Unprotected anal, vaginal, oral sex with sexual partners (casual, steady, exchange) as measured by VEE scorec | 6 months |
Mean age: 42.3 | ||||||
Male: 0% | ||||||
Diagnosis: Schizophrenia, 50%; schizoaffective disorder/ psychosis not specified, 14%; mood disorder with psychosis, 13%; mood disorder without psychosis, 23% | Intervention focus was on self-efficacy and skills training and included HIV/STI awareness, risk prevention, self-assertiveness, negotiating and practising safer sex, condom use skills; problem solving skills and commitment to self-protection (n = 39) | |||||
Ethnicity: Black, 61% | ||||||
Kalichman et al. 1995, [30]b | Outpatient psychiatric community care, Wisconsin, USA | Sample size: 52 | HIV prevention programme based on behavioral skills training (4 sessions) delivered by trained facilitators experienced in HIV risk reduction interventions. | Waiting list group (who later received the intervention) (n = 29) | Knowledge, condom use, behavior change interventions | 2 months |
Mean age: 39.2 | ||||||
Male: 52% | ||||||
Diagnosis: Schizophrenia, 62%; schizoaffective disorder, 23%; major affective disorder including bipolar, 13% | Intervention included education on risk reduction, sexual assertiveness, negotiation skills (risk-related behavioral self-management), condom use and problem-solving skills (n = 23) | |||||
Ethnicity: African-American, 19% | ||||||
Katz et al. 1996,[31]b | Outpatient psychiatric centre, California, USA | Sample size: 27 | AIDS education and risk reduction training programme (4 sessions). Details unclear on who delivered the intervention. | No treatment (n = 12) | Knowledge, behavior change interventions | 2 weeks |
Mean age: NR | ||||||
Male: NR but male female ratio 2:1 | ||||||
Diagnosis: NR but majority of patients diagnosed with schizophrenia and bipolar disorder | Intervention included education about HIV and AIDS, refusal skills training and problem solving skills (n = 15) | |||||
Ethnicity: NR | ||||||
Kelly et al. 1997,[32]b | Outpatient psychiatric care, Wisconsin, USA | Sample size: 104 | Cognitive-behavioral therapy (7 sessions) that focused on behavior changes to reduce the risk of contracting HIV. Interventions included education on risk reduction, sexual assertiveness, negotiation skills (risk-related behavioral self-management), condom use and problem-solving skills (n = 34) | A single 60 minute AIDS education session (n = 28) | AIDS risk behavior (knowledge and safer-sex practices), and condom use: barriers to behavior change and perceived risk reduction, self-efficacy for use | 3 months |
Mean age: 33.7 | ||||||
Male: 47% | ||||||
Diagnosis: Schizophrenia, 19%; mood disorder, 58%; anxiety disorder, 11%; substance use or personality disorder, 11% | ||||||
Ethnicity: African-American, 39% | Cognitive-behavioral therapy (7 sessions) combined with advocacy training (to act as a risk reduction advocate to their friends and acquaintances) (n = 42) | |||||
All interventions delivered by facilitators (no further details provided) | ||||||
Linn et al. 2003,[33]b | Homeless shelter, Nashville, USA | Sample size: 257 | Social skills training approach with cognitive-behavioral theory (6 sessions) delivered by HIV educators, a mental health professional and a ‘paraprofessional’. | HIV and STI information (6 sessions) and basic instruction on condom use (n = 127) | Unprotected anal, vaginal, oral sex with casual, occasional and regular partners (women or men) as measured by VEE scorec | 6 months |
Mean age: NR | ||||||
Male: 100% | ||||||
Diagnosis: Schizophrenia/schizoaffective disorder, 61%; major depression/ bipolar disorder, 26%; other, 14% | Intervention included Sex, Games and Videotapes with storytelling, competitive games and acting scenes with true to life scenarios (n = 130) | |||||
Ethnicity: African-American, 54% | ||||||
Malow et al. 2012, [34]b | Outpatient psychiatric clinics, Florida, USA | Sample size: 290 | Enhanced cognitive behavioral skill building programme (6 sessions) delivered by trained facilitators (no further details provided). | Health promotion including provision of information on HIV, heart attacks, good food habits, exercise, smoking and stress (n = 126) | HIV knowledge, perceived susceptibility, AIDS related anxiety, personal condom attitudes, peer and partner sexual attitudes, condom use skills, sexual self-efficacy, total number of unprotected vaginal sex acts, proportion of unprotected vaginal sex acts, total number of sex partners. | 6 months |
Mean age: 39.6 | ||||||
Male: 45% | ||||||
Diagnosis: schizophrenia, 15.7%; schizoaffective disorder, 8.4%; bipolar disorder, 9.6%; major depressive disorder, 21.2% | Intervention included HIV education, condom use, safe sex, high risk situations, and communication skills (n = 164) | |||||
Ethnicity: African-American, 55% | ||||||
NIMH 2006,[37]b | Outpatient mental health clinics, New York and Los Angeles, USA | Sample size: 99 | Living in good health together programme (7 sessions) delivered by trained facilitators (no further details provided). | A single AIDS education session including video, discussion, and referral information (n = 47) | Number of partners; number of risky sexual acts, proportion of condom use; consistent condom use | 12 months |
Mean age: NR | ||||||
Male: 100% | ||||||
Diagnosis: NR but patients with schizophrenia and bipolar disorder were eligible | Small group interventions covered knowledge of HIV, personal triggers for risk behavior, problem solving skills, condom use, assertiveness, negotiation strategies and relapse prevention (n = 52) | |||||
Ethnicity: African-American, 72.4% | ||||||
Otto-Salaj et al. 2001, [35]b | Outpatient mental health clinics, Wisconsin, USA | Sample size: 189 | HIV prevention programme (7 sessions with boosters at 1 and 2 months later) delivered by trained mental health facilitators. | Health promotion including educational discussion and skills building exercises (focused on personal relationships, stress, nutritional health, cancer, heart disease and general sexual health) (n = NR) | HIV risk knowledge, attitudes towards condom use; risk reduction behavioral intentions; frequency of protected and unprotected intercourse; intercourse occasions protected by condoms; number of partners; | 12 months |
Mean age: 38.4 | ||||||
Male: 46% | ||||||
Diagnosis: Schizophrenia, 35%; affective disorder, 34%; schizoaffective disorder, 18%; other, 13% | Intervention included HIV risk reduction, condom use, problem solving strategies, discussion and role-play, negotiation and assertiveness skills and behavior change (n = NR) | |||||
Ethnicity: African-American, 51% | ||||||
Susser et al. 1998, [36] | Homeless men, New York, USA | Sample size: 59 (sexually active) | Social skills training approach with cognitive-behavioral theory (15 sessions) delivered by a mental health professional and a ‘paraprofessional’. | Health promotion (2 sessions) including provision of information on HIV, STI and condom use (n = 26) | Unprotected anal, vaginal, oral sex with casual and occasional partners (women or men) as measured by VEE scorec | 18 months |
Mean age: NR | ||||||
Male:100% | ||||||
Diagnosis: Schizophrenia/schizoaffective disorder, 61%; major depression/ bipolar disorder, 27%; other, 12% | Intervention included Sex, Games and Videotapes with storytelling, competitive games and acting scenes with true to life scenarios (n = 33) | |||||
Ethnicity: African-American, 58% | ||||||
Weinhardt et al. 1998, [38]b | Outpatient psychiatric care, New York, USA | Sample size: 20 | Sexual assertiveness programme (10 sessions) delivered by a facilitator (no further details provided) | No treatment (n = 11) | Sexual assertiveness, knowledge, motivation, HIV risk behavior | 4 months |
Mean age: 36 | ||||||
Male: 0% | ||||||
Diagnosis: Schizophrenia spectrum disorders, 50%; bipolar disorder, 30%; major depressive disorder, 20% | Intervention included HIV related information and risk-behavior reduction, skill acquisition and fluency building and generalization of skills to actual interactions (n = 9) | |||||
Ethnicity: NR |