Heroin Cessation and Hiv Risk: A Case-Control Study

描述（由申请人提供）：本病例对照研究的目的是描述纽约市（NYC）经济条件差、主要是种族/少数民族社区内有既往慢性海洛因使用史的人持续停用海洛因的积极结局的预后指标，包括HIV感染。由于吸毒是艾滋病毒的一个主要风险因素，也是一种慢性复发性疾病，确定促进持续戒烟的因素可能是加强艾滋病毒预防和治疗工作的关键。同样未知的是，在短期和长期戒烟后，性风险会发生什么;这是一个重要但研究不足的考虑因素。由于几个原因，以前描述戒烟模式的研究受到限制。首先，虽然在复吸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却很少。其次，大多数研究都是从治疗环境中取样的，这些环境遗漏了未经治疗就停止使用的人。第三，以前的研究没有调查多个层面的决定因素的可能影响，包括停止的最初情况（例如，监禁、家庭等的影响），个体水平因素的潜在影响（例如，社会支持，网络特征）和一个人的邻居背景（例如，药物供应、艾滋病病例密度）。治疗后复发是更常见的弱势社区，人们返回设置与吸毒的线索，但比例维持停止;表征邻里因素，有助于这仍然研究不足。为了确定与持续戒烟相关的因素，我们将招募1800名海洛因使用个人利用场地和响应驱动的采样在36个纽约市社区。符合条件的个人将是那些年龄>27岁，在面试前至少五年有海洛因使用史的人。合格且同意的参与者将接受结构化访谈，包括在早期研究中成功使用的过去6年的逐年回忆。为了进行分析，将把病例定义为前海洛因使用者，即，在访谈时未使用（N=744）。指定了两个对照组：（1）在过去6年中连续使用海洛因的海洛因使用者（N=527）和（2）在过去5年中某个时候戒断但随后复吸的海洛因使用者（N=527）。在分析期间，病例（持续戒烟）和对照组将在年龄和开始使用海洛因时的年龄（<$2岁）上进行频率匹配。将使用条件logistic回归和分层模型评估持续戒烟的决定因素。本研究的数据可用于确定可改变的因素，这些因素可以受到个人，团体或政策干预，以促进持续停止使用阿片类药物。此外，我们将考虑海洛因停止作为一个“暴露”，通过检查停止和高风险性行为之间的关系。

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.