Community-Based Intervention at Needle Exchange Sites

针交换场所的社区干预

• 批准号: 6767856
• 负责人: MICHAEL S KIDORF
• 金额: $ 65万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-04-01 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6767856
• 关键词: behavior therapy; behavioral /social science research tag; clinical research; community health services; drug abuse therapy; health care referral /consultation; health care service utilization; health services research tag; human subject; hypodermic needle; interview; intravenous drug abuse; longitudinal human study; motivation; self help; substance abuse related behavior; therapy compliance

DESCRIPTION (provided by applicant): Participation in needle exchange programs (NEPs) is associated with increased use of sterile syringes, reduction in high-risk drug injection behaviors, and lower incidence of HIV seroconversion. These settings can also operate as conduits to treatment centers dedicated to reducing drug use and risk of HIV and other infectious diseases. NEP participants have severe opioid dependence, yet many are ambivalent about entering treatment programs that emphasize reductions of drug use, and interest in treatment is hindered further by limited access to immediate treatment in many areas of the country. Our current NIDA grant (Community Based Intervention at Needle Exchange Sites) shows that a single motivational enhancement session increases the treatment seeking of needle exchangers. The proposed 5-year competing continuation study builds logically on our current work and on the research of others by integrating a number of proven interventions to promote the treatment enrollment of needle exchangers. An important new component of the intervention is a procedure for helping participants return to treatment following discharge. New needle exchange participants (n = 635) will be randomly assigned to one of three study conditions: 1) Motivated Referral Condition (MRC), 2) Motivated Referral Condition plus Incentives (MRC + Incentives), or 3) Standard Referral Condition (SRC). Participants assigned to MRC only condition will be referred to 8 motivational enhancement sessions to help encourage treatment interest, and to 16 treatment readiness groups to maintain motivation and provide information on finding treatment. Those referred to the MRC + Incentives condition will receive an identical referral procedure, and will be offered incentives for complying with each aspect of the referral process, and for entering treatment. SRC participants will receive updated lists of treatment programs admitting patients. All participants who leave treatment will be referred back to the BNEP. MRC and MRC + Incentives participants will be referred from the BNEP back to the treatment readiness group, while MRC + Incentives participants will also receive incentives for attending the group and re-entering treatment. SRC participants will not receive access to the treatment readiness group, nor will they receive incentives for treatment re-entry. All participants will be followed monthly for 16 months. The primary dependent measures are rates of drug abuse treatment enrollment and re-entry, speed of enrollment and re-entry, total days in treatment, use of community resources (including the BNEP), and self-reported rates of drug use and risky behavior. This study will continue our work by expanding and strengthening the impressive public health and therapeutic benefits already achieved by many needle exchange programs.

描述（由申请人提供）：参与针头交换计划 (NEP) 与增加无菌注射器的使用、减少高风险药物注射行为以及降低 HIV 血清转化发生率相关。这些设施还可以作为通往致力于减少吸毒以及艾滋病毒和其他传染病风险的治疗中心的渠道。 NEP 参与者有严重的阿片类药物依赖，但许多人对参加强调减少药物使用的治疗计划持矛盾态度，而且该国许多地区获得立即治疗的机会有限，进一步阻碍了治疗兴趣。我们目前的 NIDA 拨款（针交换点社区干预）表明，单一的激励增强课程会增加针交换点的治疗寻求。拟议的为期 5 年的竞争性延续研究在逻辑上建立在我们当前的工作和其他人的研究的基础上，通过整合许多经过验证的干预措施来促进针交换器的治疗登记。干预措施的一个重要的新组成部分是帮助参与者出院后恢复治疗的程序。新针头交换参与者 (n = 635) 将被随机分配到以下三种研究条件之一：1) 动机转介条件 (MRC)，2) 动机转介条件加激励（MRC + 激励），或 3) 标准转介条件 (SRC)。分配至仅 MRC 条件的参与者将被转介至 8 个动机增强课程，以帮助激发治疗兴趣，并转介至 16 个治疗准备小组，以保持动机并提供有关寻找治疗的信息。那些符合 MRC + 激励条件的人将接受相同的转诊程序，并将因遵守转诊流程的各个方面以及进入治疗而获得激励。 SRC 参与者将收到接收患者的最新治疗方案清单。所有退出治疗的参与者都将被转回 BNEP。 MRC 和 MRC + 激励参与者将从 BNEP 转回治疗准备小组，而 MRC + 激励参与者还将获得参加该小组并重新接受治疗的激励。 SRC 参与者将无法进入治疗准备小组，也不会获得重新进入治疗的奖励。所有参与者将每月接受一次为期 16 个月的随访。主要的依赖指标是药物滥用治疗登记和重新登记率、登记和重新登记速度、治疗总天数、社区资源（包括 BNEP）的使用以及药物使用和危险行为的自我报告率。这项研究将继续我们的工作，扩大和加强许多针头交换计划已经取得的令人印象深刻的公共卫生和治疗效益。