A PROPOSED MODEL FOR INTEGRATING MEDICAL AND BEHAVIORAL PRACTICES

ISAAC D. MONTOYA
DAVID C. BELL

DOI: 10.2190/52GL-FFV2-N8CX-VJP8

Abstract

Background: To present four treatment models and evaluate their effectiveness in reducing HIV risk for high-risk patients. Methods: Four models are described: 1) Traditional Medical Practice Model; 2) Physician Management Model; 3) Integrated Provider-Patient Management Model; and 4) Integrated Network Treatment Model. Data from a study of 168 drug user and nonuser social networks are used to simulate the effects of each practice model on HIV transmission and seroconversion. Survey respondents described sexual and injection risk behaviors and partners for the last 30 days. An HIV risk index was computed for each individual, combining reported risk behaviors, HIV prevalence rates for partners and HIV transmission probabilities for each risk behavior. To evaluate the 4 models, 1 person from each network was selected as a "patient" and a simulation was performed to estimate the number of network members who would seroconvert to HIV over a 10-year period as affected by prevention efforts within each model. Results: The simulation projected that 99.7 persons in the social networks studied would seroconvert over 10 years without any intervention. The Integrated Network Treatment Model produced the greatest reduction in risk, producing 12.6 fewer sero-conversions over 10 years. Conclusions: The greater the patient involvement in prevention-oriented interventions, the greater the effect. The most pronounced effect occurs when a patient's unique social network is included in the prevention effort.

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