Community-Based Intervention at Needle Exchange Sites

描述(由申请人提供)：参与针头交换计划(NEP)与增加使用无菌注射器、减少高危药物注射行为和降低艾滋病毒血清转换发生率有关。这些环境还可以作为治疗中心的管道，专门用于减少药物使用和艾滋病毒和其他传染病的风险。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方案持矛盾态度，而且该国许多地区立即治疗的机会有限，进一步阻碍了人们对治疗的兴趣。我们目前的NIDA赠款(针具交换点的社区干预)表明，单一的激励性增强课程增加了针具交换者的治疗寻求。拟议的为期5年的竞争性继续研究建立在我们目前的工作和其他人的研究的基础上，通过整合一些经过验证的干预措施来促进针头交换器的治疗登记。干预的一个重要新组成部分是帮助参与者在出院后恢复治疗的程序。新的针具交换参与者(n=635)将被随机分配到三种研究条件之一：1)动机转诊条件(MRC)，2)动机转诊条件加激励(MRC+奖励)，或3)标准转诊条件(SRC)。被分配到仅有MRC情况的参与者将被转介到8次动机增强会议，以帮助鼓励治疗兴趣，并被转介到16个治疗准备小组，以保持动机并提供寻找治疗的信息。那些被转介到MRC+奖励条件的人将接受相同的转诊程序，并将为遵守转诊程序的每个方面以及进入治疗提供奖励。SRC参与者将收到接纳患者的最新治疗计划清单。所有离开治疗的参与者将被转介回BNEP。MRC和MRC+奖励计划参与者将从BNEP转回到治疗准备组，而MRC+奖励计划参与者也将获得参加小组和重新进入治疗的奖励。SRC参与者将不能进入治疗就绪组，也不能获得重新进入治疗的奖励。所有参与者将按月跟踪，为期16个月。主要的依赖指标是药物滥用治疗登记和重新进入的比率、登记和重新进入的速度、治疗的总天数、社区资源的使用(包括BNEP)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健康和治疗益处。

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.