Heroin Cessation and Hiv Risk: A Case-Control Study

描述(由申请人提供)：这项病例对照研究的目的是描述包括艾滋病毒感染在内的预后指标，以确定在纽约市(NYC)以种族/少数民族为主的经济困难社区中，有长期海洛因吸毒史的人持续戒毒的积极结果。由于吸毒是艾滋病毒和慢性复发的主要风险因素，确定促进持续戒毒的因素可能是加强艾滋病毒预防和治疗努力的关键。同样未知的是，在短期和长期停药后，性风险会发生什么；这是一个重要但尚未得到充分研究的因素。之前描述戒烟模式的研究由于几个原因而受到限制。首先，虽然在复发和戒烟方面已经做了很多工作，但关于长期有效戒烟的文献很少。其次，大多数研究都是从治疗环境中抽取样本，而这些环境中没有检测到未经治疗而停止使用药物的患者。第三，以前的研究没有在多个层面上调查决定因素的可能影响，包括戒烟的初始情况(例如，监禁、家庭等的影响)、个人层面因素的潜在影响(例如，社会支持、网络特征)和一个人的邻里环境(例如，药物可获得性、艾滋病病例密度)。治疗后复发在弱势社区更为常见，在这些社区，人们回到有吸毒线索的环境中，但有一部分人坚持戒毒；对造成这一现象的社区因素的特征仍未得到充分研究。为了确定与持续戒烟相关的因素，我们将在纽约市36个社区使用个人招募1800名海洛因，利用场地和受访者驱动的抽样。符合条件的人将是那些年龄27岁，在面试前至少有五年海洛因吸毒史的人。符合条件的和同意的参与者将接受结构化面试，包括在早期研究中成功使用的前6年的逐年回忆。为了进行分析，个案将被定义为以前吸食海洛因的人，即在访问时未使用(N=744)。设两个对照组：(1)连续吸食海洛因者(N=527)；(2)在过去5年内戒毒但后来再次吸毒者(N=527)。在分析过程中，病例(持续戒毒)和对照组将根据年龄和海洛因开始年龄(2岁)进行频率匹配。持续戒烟的决定因素将使用条件Logistic回归和分层建模进行评估。这项研究的数据可以用来确定可以接受个人、团体或政策干预的可修改因素，以促进持续戒除阿片类药物的使用。此外，我们将通过研究戒毒与高危性行为之间的关系，将海洛因戒断视为一种“暴露”。

DESCRIPTION (provided by applicant): The purpose of this case-control study is to characterize the prognostic indicators, including HIV infection, for the positive outcome of sustained heroin cessation among persons with a prior history of chronic heroin use within economically disadvantaged, predominantly racial/ethnic minority neighborhoods in New York City (NYC). With drug use as a major risk factor for HIV and a chronic relapsing condition, identifying factors that promote sustained cessation can be key to enhancing HIV prevention and treatment efforts. Also unknown is what happens with sexual risk after short and long term cessation; an important but understudied consideration. Previous studies that have described patterns of cessation have been limited for several reasons. First, while much work has been done on relapse and cessation, the literature is sparse on long- term effective cessation. Second, most studies have sampled from treatment settings which misses persons who cease use without treatment. Third, previous research has not investigated the possible impact of determinants at multiple levels, including initial circumstances of cessation (e.g., influence of incarceration, family, etc.), potential influences of individual-level factors (e.g., social support, network characteristics) and one's neighborhood context (e.g., availability of drugs, density of AIDS cases). Post treatment relapse is more common in disadvantaged communities where persons return to settings with cues for drug use, however a proportion sustains cessation; characterizing neighborhood factors that contribute to this remains understudied. To identify factors associated with sustained cessation, we will recruit 1800 heroin using individuals utilizing venue- and respondent-driven sampling in 36 NYC neighborhoods. Eligible individuals will be those aged >27 years with a history of heroin use at least five years before interview. Eligible and consenting participants will undergo structured interviews include a year by year recall for the prior 6 years as has been used successfully in earlier studies. For analyses, cases will be defined as former heroin users, i.e., non-use at interview (N=744). Two control groups are specified: (1) heroin users who used continuously through past six years, (N=527) and (2) relapsed heroin users who were abstinent sometime in the past 5 years but who subsequently relapsed to drug use (N=527). Cases (sustained cessation) and controls will be frequency matched on age and age at heroin initiation (¿2 years) during analysis. Determinants of sustained cessation will be assessed using conditional logistic regression and hierarchical modeling. Data from this study can be used to identify modifiable factors that can be subjected to individual, group or policy intervention to promote sustained cessation from opiate use. Additionally, we will consider heroin cessation as an "exposure" by examining the relation between cessation and high-risk sexual behavior.