Cell Phone Technology Targeting ART and Suboxone Adherence and Injection Drug Use

描述(由申请人提供)：当前研究的目标是通过创新的短信策略加强丁丙诺啡药物治疗，以提高复发预防技能，减少艾滋病毒危险行为，并改善丁丙诺啡和艾滋病毒治疗方案的依从性，以改善注射阿片类药物使用者的治疗。这项申请是对PAS-10-098的响应，PAS-10-098《针对艾滋病毒药物滥用人群的基于技术的依从性干预措施》，它鼓励“社会科学家、医学研究人员和技术专家之间的多学科合作，以开发和改进移动技术仪器……作为促进遵守艾滋病毒治疗方案的干预措施(或干预措施的一部分)。”与PAS声明的目标一致，本研究的具体目标是1)开发和完善基于认知行为疗法的短信干预(TXT-CBT)，以加强艾滋病毒感染、注射吸毒者和阿片类药物依赖的丁丙诺啡药物治疗；2)进行一项试点随机临床试验，以评估招募和保留个体进行大规模研究的可行性，并确定TXT-CBT对阿片类药物使用、HIV用药依从性、丁丙诺啡依从性和医疗保健结果的影响程度。MM和MM+TXT-CBT参与者将在基线、治疗结束和治疗后12周进行评估；3)检查TXT-CBT的潜在作用机制，包括自我效能、影响调节和社会支持。我们假设，与MM单独使用相比，TXT-CBT与MM联合使用将大大减少阿片类药物的使用和艾滋病毒危险行为，并将改善丁丙诺啡和HIV治疗方案的依从性。此外，我们预计MM+TXT-CBT将促进负性情感、自我效能和社会支持的更大变化，并且这些变化 将与物质使用结果相关联。TXT-CBT结合了特定的物质和依从性认知治疗技术，同时强调减少艾滋病毒危险行为。通过为最大限度地遵守艾滋病毒治疗方案提供支持，再加上应对阿片类药物复发的两个重要因素--戒断症状和压力的应对技能，TXT-CBT可能为艾滋病毒感染的阿片类药物使用者的治疗提供一种前景光明、成本效益高且易于部署的增强战略。

DESCRIPTION (provided by applicant): The objective of the current research is to improve treatment for injection opioid users by augmenting buprenorphine pharmacotherapy with an innovative text-messaging strategy to promote relapse prevention skills, reduce HIV-risk behaviors, and improve buprenorphine and HIV treatment regimen adherence. This application is in response to PAS-10-098, "Technology Based Adherence Interventions for Substance Abusing Populations With HIV," which encourages "multidisciplinary colaboration between social scientists, medical researchers, and technology experts to develop and refine mobile technological instrumentation....as interventions (or part of interventions) that foster adherence to HIV treatment regimens." Consistent with this stated objective of the PAS, the specific aims of this research are 1) To develop and refine, with user feedback, a cognitive behavioral therapy-based text-messaging intervention (TXT-CBT) to augment buprenorphine pharmacotherapy in HIV-infected,injection drug users (IDUs) with opioid dependence; 2) To conduct a pilot randomized clinical trial to assess the feasibility of recruiting and retaining individuals for a lrge scale study and to determine the effect size of TXT-CBT over and above medication management with buprenorphine (MM) on opioid use, HIV medication adherence, buprenorphine adherence, and healthcare outcomes. Both MM and MM+TXT-CBT participants will be assessed at baseline, treatment-end, and 12 weeks post-treatment; and 3) To examine potential mechanisms of action of TXT-CBT, including self-efficacy, affect regulation, and social support. We hypothesize that TXT-CBT delivered in conjunction with MM will produce greater reductions in opioid use and HIV-risk behaviors, and will improve buprenorphine and HIV treatment regimen adherence, relative to MM alone. Further, we expect that MM+TXT-CBT will facilitate greater changes in negative affect, self-efficacy, and social support, and these changes will be associated with substance use outcomes. TXT- CBT incorporates specific substance- and adherence-focused cognitive therapy techniques with a concurrent emphasis on reducing HIV-risk behaviors. By providing support to maximize HIV treatment regimen adherence, coupled with coping skills to address withdrawal symptoms and stress, two important factors in opioid relapse, TXT-CBT may provide a promising, cost-effective, and easily deployable augmenting strategy for the treatment of opioid users who are HIV-infected.