INTERVENTION AMONG HEROIN SNIFFERS--PREVENT IV DRUG USE

这一相互竞争的延续要求提供5年的资金，以继续我们的努力，减少艾滋病毒在高风险过渡到注射的非注射吸毒者中的传播。该应用程序采用创新的方法，将干预研究扩展到包括从未注射过毒品的海洛因嗅探者的注射初级预防。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将被随机分为两个实验组和一个对照组，并在6个月、12个月和18个月进行随访，以评估两种干预措施在减少高风险性行为、防止向注射过渡和增加药物治疗登记方面的有效性和可持续性。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入的过渡。有三个具体目标：1)实施、评估和比较海洛因嗅探者中两种简短的艾滋病毒风险干预措施的有效性和可持续性。对照随机实验设计将比较两种不同的干预措施，即风险预防干预和阶段增强动机访谈干预，以及“通常的测试前和测试后咨询”组。2)对吸食海洛因向注射海洛因过渡的危险因素进行表征和建模。一项具有嵌套人种学的前瞻性流行病学设计将估算注射发生率，模拟开始注射的危险因素，并描述海洛因嗅探者转向注射/早期注射经历的过渡过程。3)估计海洛因吸食者中HIV-1的患病率和发病率。将采用标准流行病学技术。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.