As we make incremental advances in fighting stigma, increasing awareness of mental illness and developing novel, effective therapies, another important challenge emerges – one that is shared across almost all disciplines: how can new knowledge be successfully and timely disseminated without wasting time but receiving the best return on the investment? Stigma still is a significant barrier to service uptake for those who are recognized as suffering from mental illnesses; prevention is likely to be one of the most important steps in addressing the burden associated with mental health issues, and yet little attention has been paid so far to preventative measures among at-risk subpopulations. As a response to these emerging needs, risk-reduction or harm-reduction research and implementation science are gaining space in mainstream mental health research. The gap between research and practice should ideally be addressed by implementation studies, which could then inform new policies and provide a roadmap to further develop and expand services. Managing psychiatric conditions among individuals with chronic, concurrent medical problems such as diabetes, hypertension, or HIV poses numerous challenges – from awareness and prevention to continuous engagement and effective treatments. Brazil’s overall response to the HIV pandemic over the past few decades, focused on prevention and treatment, has been a success story and has paved the way for initiatives targeting mental health needs and preventative strategies in this population. Wainberg et al. describe a decade-long initiative in Brazil that aimed to increase information about different behaviors among individuals with HIV, motivate engagement in safer behaviors, and transform knowledge into real-world practice. Their study was based on the accumulated experience of U.S.-based studies on the effective use of the Information-Motivation-Behavioral Skills (IMB) model to address the needs of individuals with severe mental illnesses regarding HIV, e.g., to reduce misinformation about risky sexual behaviors. Through NIMH funding, the authors conducted the PRISSMA studies (PRojeto Interdisciplinar em Sexualidade, Saúde Mental e AIDS, i.e., the Interdisciplinary Project on Sexuality, Mental Health and AIDS), which included the most current knowledge of outpatient settings in the Brazilian public health system. The pilot study found a reduction in highrisk behaviors (i.e., unprotected sex among sexually active participants in the HIV prevention group) three months post-intervention. In a current (PRISSMA-2) study, the authors determined whether HIV prevention would significantly reduce sexual risk 12 months post-intervention. The IMB model used in PRISSMA-2 was compared to an attention-control model more commonly used in managing other chronic medical conditions. For PRISSMA-2, the authors did not limit the recruitment to individuals with severe mental illness, but included individuals with common mental disorders (e.g., depression, anxiety, post-traumatic stress disorder, etc.). Assigning more than 400 participants to either an IMBbased HIV prevention group (n=233) or a health promotion group (n=231), Wainberg et al. found that after 12 months both groups reported reductions in high-risk behaviors, i.e., the number of occasions of unprotected vaginal or anal intercourse. The IMB model, however, was more successful in improving knowledge about HIV, increasing motivation for safer sex, and increasing HIV prevention behavioral skills. The study demonstrated that clinicians could sucessfully implement interventions to reduce the likelihood of risky sexual behavior among patients with mental illness, even with the limited resources of a public-funded health system in Brazil. One noteworthy methodological advancement was comparing an intervention group with another attentioncontrol intervention group, rather than with treatment as usual, which better served evidence-based best practices. The authors also assessed the consistency and fidelity with which the intervention was administered, including adaptations and long-term effects on individual and setting levels. As implementation science aims to close to gap between research and practice, Wainberg et al. have provided us with a local roadmap, built over the course of a decade, about how to strike a balance between state-ofthe-art methodology, scientific rigor, and the needs of the community, conducting a study that promises meaningful change in a sustainable way.

中文翻译：

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在高危人群中实施心理健康变化：巴西长达十年的路线图

随着我们在打击污名化、提高对精神疾病的认识和开发新颖有效的疗法方面取得渐进式进展，出现了另一个重要挑战——几乎所有学科都面临这一挑战：如何成功、及时地传播新知识，而不浪费时间，而是接受最佳投资回报？对于那些被认为患有精神疾病的人来说，污名仍然是他们接受服务的重要障碍；预防可能是解决与心理健康问题相关的负担的最重要步骤之一，但迄今为止，对高危亚群的预防措施关注甚少。作为对这些新兴需求的回应，降低风险或减少伤害的研究和实施科学在主流心理健康研究中获得了空间。理想情况下，研究和实践之间的差距应该通过实施研究来解决，然后可以为新政策提供信息，并为进一步开发和扩展服务提供路线图。在患有糖尿病、高血压或 HIV 等慢性并发疾病的个体中管理精神疾病带来了许多挑战——从意识和预防到持续参与和有效治疗。巴西在过去几十年中对艾滋病毒大流行的整体反应，侧重于预防和治疗，取得了成功，并为针对这一人群的心理健康需求和预防策略的举措铺平了道路。温伯格等人。描述了巴西一项为期十年的倡议，该倡议旨在增加有关 HIV 感染者不同行为的信息，激励人们采取更安全的行为，并将知识转化为现实世界的实践。他们的研究基于美国研究的积累经验，这些研究有效利用信息-动机-行为技能 (IMB) 模型来解决患有严重精神疾病的个人对 HIV 的需求，例如减少有关危险性行为的错误信息。行为。通过 NIMH 资助，作者进行了 PRISSMA 研究（Projeto Interdisciplinar em Sexualidade、Saúde Mental e AIDS，即性、心理健康和艾滋病跨学科项目），其中包括巴西公共卫生系统门诊环境的最新知识. 试点研究发现，在干预后三个月，高危行为（即 HIV 预防组的性活跃参与者之间无保护的性行为）有所减少。在当前的 (PRISSMA-2) 研究中，作者确定了 HIV 预防是否会在干预后 12 个月显着降低性风险。将 PRISSMA-2 中使用的 IMB 模型与更常用于管理其他慢性疾病的注意力控制模型进行了比较。对于 PRISSMA-2，作者没有将招募限制为患有严重精神疾病的个体，而是包括患有常见精神障碍（例如，抑郁、焦虑、创伤后应激障碍等）的个体。Wainberg 等人将 400 多名参与者分配到基于 IMB 的 HIV 预防组（n=233）或健康促进组（n=231）。发现 12 个月后，两组均报告高风险行为减少，即无保护阴道或肛门性交的次数。然而，IMB 模式在提高对 HIV 的了解、增加安全性行为的动机以及提高 HIV 预防行为技能方面更为成功。该研究表明，即使巴西公共资助的卫生系统资源有限，临床医生也可以成功实施干预措施，以减少精神疾病患者发生危险性行为的可能性。一个值得注意的方法学进步是将一个干预组与另一个注意力控制干预组进行比较，而不是像往常一样进行治疗，后者更好地服务于基于证据的最佳实践。作者还评估了干预措施的一致性和保真度，包括对个人和环境水平的适应性和长期影响。由于实施科学旨在缩小研究与实践之间的差距，Wainberg 等人。为我们提供了一份历时十年制定的当地路线图，内容涉及如何在最先进的方法论、科学严谨性和社区需求之间取得平衡，开展一项有望在可持续发展方面实现有意义变革的研究办法。