Relapse prevention to reduce HIV among women prisoners

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DESCRIPTION (provided by applicant): Women with histories of opioid dependence prior to incarceration are a group at high risk for relapse to active opioid use and HIV-risk behaviors after release. Prisoners have HIV rates more than three times the general population largely due to their drug use prior to incarceration. Research has consistently demonstrated the link between drug use, crime, arrest, and incarceration and most inmates do not receive drug treatment during incarceration or after release. Development of post-release interventions that can prevent relapse to active drug use are important to reduce recidivism and HIV risk behaviors. To begin to address this need, we propose examining the feasibility and acceptability of a novel medication, buprenorphine, combined with Medication Management (MM) initiated during the last 2-4 weeks of incarceration and continued for 12 weeks in the community. The primary aims of this research plan are to examine the acceptability and feasibility of using buprenorphine combined with MM for women at high risk for opioid relapse and subsequent HIV infection. We proposed to initially implement the active intervention (buprenophine and MM) with 10 participants leaving prison as part of a pre-pilot study. All participants would be started on the active intervention in prison and continued with the intervention for 12 weeks after release and complete a follow-up at 24 weeks post-release. Next we would conduct a small randomized, double- blind placebo-controlled pilot study that would examine the feasibility and acceptability of administering buprenorphine combined with MM to placebo plus MM to 40 women with histories of opioid dependence who are within four weeks of release back to the community. Both groups would receive weekly buprenorphine or placebo plus MM during the first 8 weeks after release, followed by 10 and 12 week sessions. The primary outcome variable would be the acceptability and feasibility of this intervention. Another primary outcome would compare the two groups on HIV-related risk variables including opioid use and sexual risk at 12 and 24 weeks post-release. Secondary outcomes include use of other illicit drugs or alcohol, as well as engaging in other criminal behavior after release. If this intervention is both acceptable and feasible, this would provide pilot data for a larger efficacy trial to investigate interventions for HIV-prevention among opioid-dependent prisoners released back to the community.