Heroin Cessation and Hiv Risk: A Case-Control Study

海洛因戒断和艾滋病毒风险：病例对照研究

• 批准号: 7498006
• 负责人: DAVID VLAHOV
• 金额: $ 63.95万
• 依托单位: NEW YORK ACADEMY OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-20 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7498006
• 关键词: AIDS prevention; Abstinence; Acquired Immunodeficiency Syndrome; Age; Age-Years; Awareness; Case-Control Studies; Censuses; Characteristics; Child; Chronic; Cities; Cocaine; Communities; Condition; Consent; Control Groups; Counseling; Criminal Justice; Cues; Data; Disadvantaged; Drug Metabolic Detoxication; Drug abuse; Drug usage; Epidemiology; Ethnic Origin; Ethnography; Event; Factor Analysis; Family; Frequencies; Goals; HIV; HIV Infections; Heroin; Heroin Users; Human immunodeficiency virus test; Imprisonment; Incidence; Individual; Injection of therapeutic agent; Intervention; Interview; Jamaica; Libido; Life; Literature; Location; Logistic Regressions; Long Island; Maps; Marital Status; Medical; Methadone; Methods; Minority Groups; Modeling; Narcotics; Natural History; Neighborhoods; New York City; Opiates; Opioid; Outcome; Overdose; Participant; Patient Self-Report; Pattern; Persons; Pharmaceutical Preparations; Policies; Population; Purpose; Race; Recording of previous events; Recovery; Recruitment Activity; Relapse; Replacement Therapy; Reporting; Research; Research Personnel; Respondent; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Route; Sampling; Services; Sexual Partners; Social support; Specific qualifier value; Structure; System; Techniques; Testing; Therapeutic; Time; Unsafe Sex; Urine; Visit; Work; base; case control; demographics; density; experience; high risk sexual behavior; land use; outreach; prognostic; programs; segregation; sex; success

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.

描述（由申请人提供）：本病例对照研究的目的是表征预后指标，包括HIV感染，在纽约市（NYC）经济上处于不利地位的主要种族/少数民族社区中，有长期海洛因使用史的人持续海洛因戒烟的积极结果。由于吸毒是艾滋病毒的主要危险因素和慢性复发状况，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。同样未知的是短期和长期戒烟后的性风险；一个重要但未被充分研究的考虑因素。先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取样的，这遗漏了那些未经治疗就停止使用药物的人。第三，以前的研究没有调查决定因素在多个层面上的可能影响，包括戒烟的初始环境（例如，监禁的影响，家庭等），个人层面因素的潜在影响（例如，社会支持，网络特征）和一个人的社区环境（例如，药物的可获得性，艾滋病病例的密度）。治疗后复发在弱势社区更为常见，那里的人回到有吸毒线索的环境中，但有一部分人坚持戒烟；表征邻里因素的贡献，这仍有待进一步研究。为了确定与持续戒烟相关的因素，我们将在纽约市36个社区招募1800名海洛因使用者，利用场地和受访者驱动的抽样。符合条件的个人将是年龄在bb0 - 27岁之间，在面谈前至少有5年海洛因使用史的人。符合条件和同意的参与者将接受结构化访谈，包括前6年的逐年回忆，这在早期研究中已成功使用。为了进行分析，病例将被定义为前海洛因使用者，即在访谈时未使用（N=744）。指定两个对照组：(1)过去6年持续使用海洛因的吸毒者（N=527）；(2)过去5年一度戒断，但随后又重新使用海洛因的吸毒者（N=527）。在分析期间，病例（持续戒烟）和对照将根据年龄和海洛因起始年龄（2岁）进行频率匹配。持续戒烟的决定因素将使用条件逻辑回归和分层模型进行评估。本研究的数据可用于确定可通过个人、团体或政策干预促进持续停止使用阿片类药物的可修改因素。此外，我们将通过检查戒烟与高危性行为之间的关系，将海洛因戒烟视为一种“暴露”。