Intervention of HIV, Drug Use and the Criminal Justice System in Malaysia

马来西亚艾滋病毒、吸毒和刑事司法系统的干预

• 批准号: 7579599
• 负责人: FREDERICK LEWIS ALTICE
• 金额: $ 58.18万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-30 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7579599
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Anti-HIV Agents; Behavior; Behavior Therapy; Behavioral; Caring; Chemicals; Collaborations; Communities; Control Groups; Counseling; Criminal Justice; DSM-IV; Daily; Dependency; Developed Countries; Diagnostic and Statistical Manual; Drug Addiction; Drug abuse; Drug usage; Eastern Europe; Epidemic; Evidence based intervention; Evidence based treatment; Frequencies; Grant; HIV; HIV Infections; HIV diagnosis; Health; Heroin; Highly Active Antiretroviral Therapy; Holistic Health; Imprisonment; Injecting drug user; Injection of therapeutic agent; International; Intervention; Intervention Studies; Maintenance; Malaysia; Malaysian; Methadone; Methodology; Modeling; NIH Program Announcements; Numbers; Opiate Addiction; Opiates; Opioid; Outcome; Pharmaceutical Preparations; Prevalence; Prevention approach; Preventive; Prisoner; Prisons; Public Health; Quality of life; Randomized Controlled Trials; Recovery; Relapse; Research; Research Personnel; Risk; Risk Behaviors; Risk Reduction; Risk-Taking; Severities; Southeastern Asia; Substance abuse problem; System; Target Populations; Testing; Time; Treatment outcome; Urine; Work; addiction; authority; base; community reentry; day; design; experience; improved; interest; pandemic disease; programs; prospective; recidivism; response; sex; southeast Asian; transmission process; trend; vector transmission

DESCRIPTION (provided by applicant): Despite a wide array of HIV prevention approaches and related research, there is a decade-long trend of 11,000 new HIV diagnoses each day globally. Injection drug users (IDUs) remain a target population as they represent a significant vector for the transmission of new HIV infections, which occur through preventable drug- and sex- related HIV risk behaviors. The criminal justice approach to addressing chemical dependency has primarily been incarceration, resulting in concentration of HIV+ in prison settings. A number of evidence-based HIV risk reduction interventions are now widely available as complete behavioral intervention packages. Very few evidence-based interventions have been designed and adapted for HIV+ prisoners transitioning from the prison to the community setting. None have used integrated models. Methadone maintenance treatment (MMT), an evidence-based pharmacological approach to treating opioid dependence, has also not been widely implemented as a secondary HIV risk reduction intervention for released prisoners. MMT has been demonstrated to reduce drug- related injection risks, but arguably has little influence on sexual risk-taking. Public health authorities struggle to implement best practice interventions to intercede with HIV transmission among IDUs, who routinely interface with criminal justice system. As part of our specific aims, we propose: 1) to create a new prison-release behavioral counseling intervention, "Positive Transitions" (PT), by adapting the Holistic Health Recovery Project for HIV+s (HHRP+) for prisoners released to the community and within the Malaysian context in order to improve health outcomes and reduce HIV transmission behaviors; and 2) using a 2x2 multi-factorial design, to conduct a prospective, randomized controlled trial of HIV+ prisoners who meet DSM- IV criteria for opioid dependence to compare prison-release as usual (control group) versus Positive Transitions alone, MMT alone, or the combination of MMT plus Positive Transitions to determine the optimal prison-release intervention. Results from this trial will inform public health authorities about how to best reduce HIV transmission among released HIV+ prisoners with opioid dependence. A team of U.S. and Malaysian investigators with significant previous collaboration and expertise with prisoners, HIV infection, substance abuse treatment and behavioral intervention research pools their collective experience to assist in answering important public health questions regarding evidence-based interventions for released HIV+ prisoners. PUBLIC HEALTH RELEVANCE: HIV+ prisoners with opioid dependence figure greatly in fueling the 11,000 new daily HIV infections globally. Effective prison-release programs that target HIV risk reduction for HIV+s have not been developed or studied using rigorous methodologies. This 2x2 multifactorial, randomized controlled trial of methadone maintenance treatment and an evidence-based behavioral intervention for HIV+s (Holistic Health Recovery Project) will advise public health authorities about how to best intervene with HIV+ prisoners who are transitioning from prison to the community.

描述(申请人提供)：尽管有广泛的艾滋病毒预防方法和相关研究，但十年来全球每天有11,000例新的艾滋病毒诊断病例。注射吸毒者(注射吸毒者)仍然是目标人群，因为他们是传播新的艾滋病毒感染的重要媒介，新的艾滋病毒感染通过可预防的与毒品和与性有关的艾滋病毒危险行为发生。解决化学品依赖问题的刑事司法办法主要是监禁，导致艾滋病毒+病毒集中在监狱环境中。许多基于证据的减少艾滋病毒风险的干预措施现在作为完整的行为干预方案广泛可用。为艾滋病毒携带者从监狱过渡到社区环境而设计和调整的循证干预措施很少。没有一家公司使用过集成模型。美沙酮维持治疗(MMT)是一种治疗阿片类药物依赖的循证药理学方法，也没有作为对获释囚犯的二次艾滋病毒风险降低干预措施广泛实施。MMT已被证明可以降低与药物相关的注射风险，但可以说对于性风险的影响很小。公共卫生当局努力实施最佳做法干预措施，以干预注射吸毒者之间的艾滋病毒传播，这些注射吸毒者通常与刑事司法系统对接。作为我们具体目标的一部分，我们建议：1)创建一种新的监狱释放行为咨询干预措施--“积极过渡”(PT)，通过为被释放到社区和马来西亚背景下的囚犯调整艾滋病毒+S整体健康恢复项目(HHRP+)，以改善健康结果，减少艾滋病毒传播行为；2)使用2x2多因素设计，对符合DSM-IV阿片类药物依赖标准的HIV+囚犯进行前瞻性随机对照试验，比较正常释放监狱(对照组)和单独使用MMT、单独使用MMT或联合使用MMT和积极转换药物，以确定最佳的释放监狱干预措施。这项试验的结果将向公共卫生当局通报如何最好地减少艾滋病毒+阿片依赖获释囚犯中的艾滋病毒传播。一个由美国和马来西亚的调查人员组成的团队在囚犯、艾滋病毒感染、药物滥用治疗和行为干预研究方面拥有丰富的合作和专业知识，他们汇集了他们的集体经验，以帮助回答有关对获释的艾滋病毒+囚犯进行循证干预的重要公共卫生问题。 公共卫生相关性：艾滋病毒+阿片类药物依赖囚犯在全球每天新增11,000例艾滋病毒感染病例中占很大比例。针对艾滋病毒+S降低艾滋病毒风险的有效监狱释放计划尚未制定或使用严格的方法进行研究。这项关于美沙酮维持治疗和针对艾滋病毒+S(整体健康恢复项目)的循证行为干预的2x2多因素随机对照试验将就如何最好地干预正在从监狱过渡到社区的艾滋病毒+囚犯向公共卫生当局提供建议。