COMMUNITY BASED INTERVENTION AT NEEDLE EXCHANGE SITES

针具交换方案旨在为注射毒品使用者提供方便的无菌针具和注射器，以减少共用受污染设备的频率，从而降低传播艾滋病毒和其他血液传播疾病的风险。大多数项目还建议参与者不要继续使用药物，并向那些要求药物滥用治疗的人提供药物滥用治疗转介，但只有少数人真正寻求转介治疗。拟议的3年研究将系统地评估一种有希望的以社区为基础的干预措施，以鼓励阿片类药物滥用者参加治疗。 在巴尔的摩市针头交换计划（n=1011）的新登记者将首先评估药物使用率和其他精神病诊断，药物使用和心理社会问题的严重程度，艾滋病毒药物使用和性风险的严重程度。 符合美沙酮治疗条件的患者（n=807）将被随机分配到三种治疗转诊策略之一：1）自我转诊（SR），2）动机增强（ME）和3）注意力控制（AC）。 SR参与者将自行联系常规针具交换工作人员，了解对治疗转诊的任何兴趣;这是通常的程序。 ME受试者将接受一次结构化的动机访谈，重点介绍参与治疗的获益和后果（米勒和Rollnick，1991），然后要求他们表明是否有兴趣转诊治疗。 注意力控制转介小组（AC）将通过让参与者参加工作准备面试，然后询问他们是否对治疗转介感兴趣，来控制与ME参与者在一起的时间。 所有要求药物滥用治疗的参与者将进入治疗转介行动阶段，进入专门用于针具交换计划的非美沙酮（如有要求）或美沙酮治疗槽（n=250）。 主要的依赖性指标是：1）每种情况下请求治疗转诊的参与者比例; 2）进入治疗的参与者比例。 所有研究参与者将在注册后随访10-16个月（取决于他们是否以及何时进入治疗），以确定是否使用交换计划（即，接受治疗的天数和注射器交换）;还将确定接受治疗者的保留率。 拟议的研究将提供新的和重要的信息，新的针交换登记的问题特征。 这些数据还将用于预测对转诊干预措施的反应。 在这项研究中评估的动机干预是一个合乎逻辑的下一步，以加强令人印象深刻的公共卫生福利已经取得了大多数针头交换计划。 重要的是，这种干预可以很容易地纳入大多数交流项目的常规做法。

Needle exchange programs were designed to provide injection drug users with ready access to sterile needles and syringes to reduce the frequency of sharing contaminated equipment and thereby lower the risk of transmitting HIV and other blood borne diseases. Most programs also counsel participants against continued drug use and offer drug abuse treatment referrals to those who request one, but only a minority actually pursue referral into treatment. The proposed 3-year study will systematically evaluate a promising community-based intervention for encouraging opiate abusers to enroll in treatment. New registrants at the Baltimore City Needle Exchange Program (n=1011) will be first assessed for rates of substance use and other psychiatric diagnoses, severity of substance use and psychosocial problems, and HIV drug use and sexual risk severity. Those who are methadone eligible (n=807) will be randomly assigned to one of three treatment referral strategies: 1) self-referral (SR),2) motivational enhancement (ME), and 3) attention control (AC). SR participants will contact routine needle exchange staff on their own about any interest in a treatment referral; this strategy is the usual procedure. ME participants will be administered a structured motivational interview highlighting the benefits and consequences of treatment participation (Miller and Rollnick, 1991) and then asked to indicate their interest in a referral to treatment. An attention control referral group (AC) will control for time spent with ME participants by engaging participants in a job readiness interview and then asking if they are interested in a treatment referral. All participants requesting drug abuse treatment will move to a treatment referral action phase enroute to admission to non-methadone (if requested) or methadone treatment slots dedicated to the needle exchange program (n=250). The primary dependent measures are: 1) proportion of participants in each condition who request a treatment referral; 2) proportion of participants who enter treatment. All study participants will be followed for 10-16 months (depending on if and when they entered treatment) following registration to determine use of the exchange program (i.e., number of days attended and syringe exchanges); retention rates will also be determined in those who enter treatment. The proposed study will provide new and important information on the problem characteristics of new needle exchange enrollees. This data will also be used to predict response to the referral interventions. The motivational intervention evaluated in this study is a logical next step to strengthen the impressive public health benefits already achieved by most needle exchange programs. Importantly, this intervention can be easily incorporated as routine practice in most exchange programs.