Community-Based Intervention at Needle Exchange Sites

描述（由申请人提供）：参与针头交换计划（NEP）与无菌注射器的使用增加、高危药物注射行为减少和HIV血清转化发生率降低相关。这些机构还可以作为专门用于减少吸毒和艾滋病毒和其他传染病风险的治疗中心的管道。NEP参与者有严重的阿片类药物依赖，但许多人对进入强调减少药物使用的治疗计划持矛盾态度，并且在该国许多地区获得立即治疗的机会有限，进一步阻碍了对治疗的兴趣。我们目前的NIDA补助金（针具交换点的社区干预）表明，一个单一的动机增强会议增加了针具交换者的治疗寻求。拟议的5年竞争性继续研究在逻辑上建立在我们目前的工作和其他人的研究基础上，通过整合一些已证实的干预措施来促进针具交换器的治疗入组。干预的一个重要的新组成部分是帮助参与者在出院后重新接受治疗的程序。新的针头交换参与者（n = 635）将被随机分配到三种研究条件之一：1）动机性转诊条件（MRC），2）动机性转诊条件加激励（MRC +激励），或3）标准转诊条件（SRC）。被分配到MRC唯一条件的参与者将被转介到8个动机增强会议，以帮助鼓励治疗兴趣，并被转介到16个治疗准备小组，以保持动机并提供有关寻找治疗的信息。那些被转介到MRC +奖励条件的人将接受相同的转介程序，并将为遵守转介过程的每个方面和接受治疗提供奖励。SRC参与者将收到最新的收治患者的治疗方案清单。所有离开治疗的参与者将被转介回BNEP。MRC和MRC +奖励参与者将从BNEP转介回治疗准备小组，而MRC +奖励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。所有参与者将每月随访一次，持续16个月。主要的依赖性指标是药物滥用治疗登记率和再入组率、登记速度和再入组速度、治疗总天数、社区资源的使用（包括BNEP）以及自我报告的药物使用率和危险行为。这项研究将继续我们的工作，扩大和加强令人印象深刻的公共卫生和治疗效益已经取得了许多针交换计划。

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.