Community-Based Intervention at Needle Exchange Sites

针交换场所的社区干预

• 批准号: 8434266
• 负责人: MICHAEL S KIDORF
• 金额: $ 63.12万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-04-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8434266
• 关键词: Adherence; Admission activity; Area; Baltimore; Behavior; Behavior Therapy; Behavioral; Caring; Clinical assessments; Communicable Diseases; Communities; Counseling; Data; Dose; Drops; Drug abuse; Early treatment; Effectiveness; Enrollment; Equipment; Exposure to; Funding; HIV risk; Harm Reduction; Health; Health Personnel; Incentives; Individual; Injecting drug user; Injection of therapeutic agent; Intervention; Left; Maintenance; Measures; Methadone; Methods; Modeling; Motivation; National Institute of Drug Abuse; Needle Sharing; Needle-Exchange Programs; Opioid; Outcome; Outcome Measure; Outpatients; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacotherapy; Policy Maker; Population; Psychiatric therapeutic procedure; Psychological reinforcement; Randomized; Readiness; Reporting; Resources; Risk Behaviors; Sampling; Schedule; Services; Severities; Shelter facility; Site; Source; Structure; Subgroup; Syringes; Testing; Treatment Cost; Treatment Effectiveness; Treatment outcome; United States National Institutes of Health; Urinalysis; Work; alternative treatment; base; comparison group; design; disorder risk; evidence base; high risk; high risk behavior; improved; indexing; interest; methadone maintenance; motivational intervention; novel; primary outcome; programs; psychologic; psychosocial; public health relevance; routine care; satisfaction; substance abuse treatment; treatment duration; treatment program; voucher

DESCRIPTION (provided by applicant): Participants in community-based syringe exchange programs (SEPs) engage in rates of injection drug use that exceed those reported in other populations of substance users (Wood et al., 2007). Prior work by our group has shown that a combination approach incorporating motivational and behavioral interventions is associated with increased rates of methadone treatment enrollment and reduced rates of drug use and other high risk behaviors (Kidorf & Brooner, 2006). Neverthleless, referrals from the SEP achieved worse outcomes in methadone treatment compared to those referred from other sources, including higher rates of drug use and attrition (Kidorf & Brooner, 2006). The proposed 5-year competing continuation application extends our previous work by evaluating stepped-based induction strategies to improve retention and other outcomes of syringe exchangers entering methadone treatment. Opioid-dependent Baltimore Needle Exchange (BNEP) participants (n = 520) that express interest in methadone treatment will complete a clinical assessment battery and be randomly assigned to one of three 3-month treatment induction strategies. The first is a low threshold induction (LTSC) that is broadly modeled on interim methadone maintenance (Schwartz et al., 2006) and designed to more gradually transition SEP participants to the daily structure of maintenance treatment while maximizing exposure to methadone pharmacotherapy. The second is a voucher-based intervention that uses monetary incentives to reinforce treatment engagement to schedules of methadone dosing and stepped-based counseling. The final condition (RSC) will expose participants to routine stepped-care. Participants in all conditions will receive routine stepped care during the final 3-months of participation. All participants will be stabilized on methadone (90 mg) and followed weekly for 6-months. A structured readmission intervention will be used across conditions in efforts to re-engage participants leaving treatment in the context of drug use (Brooner & Kidorf, 2002). Retention, drug use (urinalysis and self-report), and other risk behaviors are the primary outcome measures. Mediational models will evaluate the impact of changes in treatment readiness and satisfaction as predictors of outcome. These findings will inform the field on evidenced-based strategies to optimize methadone treatment effectiveness for this important subgroup of injection opioid users.

描述（由申请人提供）：社区注射器交换计划（sep）的参与者参与的注射药物使用率超过了其他物质使用者人群的报告（Wood等，2007）。我们小组先前的工作表明，结合动机和行为干预的组合方法与美沙酮治疗登记率的增加和吸毒和其他高风险行为的减少有关（Kidorf & Brooner, 2006）。然而，与其他来源的转诊相比，SEP转诊的美沙酮治疗效果更差，包括更高的药物使用率和损耗率（Kidorf & Brooner, 2006）。拟议的5年竞争延续申请扩展了我们之前的工作，通过评估基于分步的诱导策略来改善进入美沙酮治疗的注射器交换器的保留和其他结果。表示对美沙酮治疗感兴趣的阿片类药物依赖巴尔的摩针头交换（BNEP）参与者（n = 520）将完成临床评估，并随机分配到三种为期3个月的治疗诱导策略之一。第一种是低阈值诱导（LTSC），广泛模仿中期美沙酮维持（Schwartz et al., 2006），旨在更逐步地将SEP参与者过渡到日常维持治疗结构，同时最大限度地暴露于美沙酮药物治疗。第二种是基于代金券的干预，使用金钱激励来加强对美沙酮剂量和分步咨询时间表的治疗参与。最终条件（RSC）将使参与者接受常规的逐步护理。所有情况下的参与者在参与的最后3个月将接受常规的阶梯式护理。所有参与者将稳定使用美沙酮（90mg），每周随访6个月。一个结构化的再入院干预将在各种情况下使用，以努力重新吸引在药物使用背景下离开治疗的参与者（Brooner & Kidorf, 2002）。留用、药物使用（尿液分析和自我报告）和其他危险行为是主要的结果衡量指标。中介模型将评估治疗准备和满意度变化的影响，作为结果的预测因子。这些发现将为该领域提供循证策略，以优化美沙酮治疗这一重要注射阿片类药物使用者亚群的有效性。