INTERVENTION AMONG HEROIN SNIFFERS--PREVENT IV DRUG USE

这种竞争的延续需要5年的资金，以继续努力减少艾滋病毒在向注射过渡的高风险的非注射吸毒者中的传播。这项应用采用了一种创新的方法，将干预研究扩展到包括从未注射过毒品的海洛因嗅探者中注射的一级预防。提出了一种具有嵌套人种学的前瞻性实验设计。750名吸食海洛因的男性和女性的三个种族样本将被纳入并随机分为两个实验干预和一个对照组，并在6个月、12个月和18个月时进行跟踪，以评估两种干预措施的有效性和可持续性，以减少高危性行为，防止过渡到注射，并增加药物治疗的登记人数。我们提出了一种有效的设计，使我们能够同时实施和评估干预措施的有效性，并前瞻性地研究向注射的过渡。有三个具体目标：1)在海洛因嗅探者中实施、评估和比较两种简短的艾滋病毒风险干预措施的有效性和可持续性。一项对照随机实验设计将比较两种不同的干预措施，一种是风险预防干预，一种是阶段强化的动机访谈干预，另一组是“通常的测试前和测试后咨询”组。2)确定海洛因从嗅探向注射转变的危险因素，并建立模型。一项带有嵌套人种学的前瞻性流行病学设计将估计注射发生率，模拟开始注射的危险因素，并描述转变为注射/早期注射的海洛因吸毒者转变为注射的过程。3)估计吸毒者中HIV-1的流行率和发病率。将采用标准的流行病学技术。将进行针对性别和族裔的估计。

This competing continuation requests 5 years of funding to continue our efforts to reduce the transmission of HIV among non- injection drug users at high risk for transition to injection. This application takes the innovative approach of extending intervention research to include the primary prevention of injection among heroin sniffers who have never injected drugs. A prospective experimental design with a nested ethnography is proposed. A tri-ethnic sample of 750 men and women who sniff heroin will be enrolled and randomized to two experimental interventions and one comparison group and followed at 6, 12, and 18 months to evaluate the effectiveness and sustainability of two interventions to reduce high risk sex behaviors, prevent the transition to injection and increase enrollment in drug treatment. We propose an efficient design which permits us to simultaneously implement and evaluate the effectiveness of the interventions and prospectively study the transition to injection. There are three specific aims: 1) Implement, evaluate and compare the effectiveness and sustainability of two brief HIV risk interventions among heroin sniffers. A controlled randomized experimental design will compare two distinct interventions, a Risk Prevention Intervention and a Stage-Enhanced Motivational Interviewing Intervention with a"usual pre-and post-test counseling" group. 2) Characterize and model risk factors for the transition from heroin sniffing to injection. A prospective epidemiologic design with a nested ethnography will estimate incidence of injection, model risk factors for initiation of injection, and characterize the process of transition to injection/early injection experiences of heroin sniffers who shift to injection. 3) Estimate the prevalence and incidence of HIV-1 among heroin sniffers. Standard epidemiologic techniques will be employed. Gender specific and ethnic specific estimates will be conducted.