Medication Assisted Therapy as a Conduit to Care for HIV+ CJS Populations Transit

描述（由申请人提供）：这是一个独立的科学家奖，旨在帮助Sandra施普林格博士继续研究，她的研究重点是干预措施，这些干预措施将改善与艾滋病毒+刑事司法人群（CJS）的联系，这些人群患有共病物质使用障碍，正在向社区过渡。这个奖项也将增加她的时间，致力于指导年轻的研究者谁分享这个兴趣。艾滋病毒和药物滥用集中在CJS内，因此，它是针对减少社区内艾滋病毒传播战略的干预措施进行针对性和经验测试的重要场所。当艾滋病毒被最大限度地抑制时，其结果是传染性降低。艾滋病毒阳性囚犯在监禁期间成功地实现了抑制，但释放后3个月病毒抑制丧失，主要是由于吸毒和酗酒复发。阿片类药物依赖（OD）和酒精依赖（AD）存在于全国50-70%的艾滋病毒阳性囚犯中。药物使用的复发与停止坚持HAART治疗和增加艾滋病毒风险行为有关，这是艾滋病毒传播的完美风暴。有效治疗吸毒过量和阿尔茨海默病阻断了这种关系，并有很大的潜力改善艾滋病毒的结局。阿片类药物替代疗法，特别是美沙酮，由于哲学、安全、监管和人员配备方面的考虑，在CJS中应用有限。同样，针对AD的药物干预在CJS中基本上不存在。因此，检查纳曲酮（NTX）（一种经FDA批准用于治疗OD和AD的阿片类拮抗剂）疗效的策略，以提高依从性和保留治疗，具有极大的吸引力，有利于个人和减少社区内的艾滋病毒传播。施普林格博士已经获得了2个R01（项目1，NIDA R01 DA030762；项目2，R01 AA018944），作为这个独立科学家奖的研究平台。这两项研究的具体目的是对正在向社区过渡的HIV+囚犯（项目1）和AD（项目2）进行延期释放NTX （XR- NTX）的安慰剂对照RCT。安慰剂对照方法进一步强化了任何应该被证明的发现。HIV治疗、药物滥用、不良副作用和HIV风险行为结果将在纽黑文、哈特福德和斯普林菲尔德的CJS受试者中进行比较。这种治疗方法对CJS有很大的吸引力，因为每月注射很容易，没有转移，副作用很少，而且对其使用没有对抗的哲学担忧。这项提议的优势在于施普林格博士在艾滋病毒，成瘾和CJS方面经验丰富；药物干预的新应用，以防止吸毒过量和阿尔茨海默病复发，作为改善艾滋病毒预后的手段；在CJS从事研究工作7年以上；以及使用XR-NTX治疗OD和AD的新颖性。这些试验可能会证明有效性和安全性，然后XR-NTX可能会成为释放的艾滋病毒阳性囚犯的循证干预措施。因此，个人、我们的医疗保健系统和社会都很有可能受益——特别是在社区内减少艾滋病毒。

DESCRIPTION (provided by applicant): This is an independent scientist award to assist in the continued research of Dr. Sandra Springer, who focuses her research on interventions that will improve linkages to care for HIV+ criminal justice populations (CJS) with co-morbid substance use disorders who are transitioning to the community. This award will also increase her time to devote towards mentoring young investigators who share this interest. HIV and drug abuse is concentrated within the CJS, therefore, it is an important place to target and empirically test interventions that address strategies to reduce HIV transmission within the community. When HIV is maximally suppressed decreased infectiousness is the result. HIV+ prisoners successfully achieve suppression during incarceration, however 3 months post-release viral suppression is lost, mostly due to relapse to drugs and alcohol. Opioid dependence (OD) and alcohol dependence (AD) are present in 50-70% of HIV+ prisoners nationally. Relapse to substance use is associated with discontinuation of HAART adherence and increased HIV risk behaviors, the perfect storm for HIV transmission. Effectively treating OD and AD interrupts this relationship and has great potential to improve HIV outcomes. Opioid substitution therapy, especially methadone, has had limited uptake within the CJS due to philosophical, safety, regulatory and staffing concerns. Similarly, pharmacologic interventions to target treatment of AD are essentially nonexistent within the CJS. Therefore, strategies examining the efficacy of naltrexone (NTX), an opioid antagonist approved by the FDA for treatment of both OD and AD, to improve adherence and retention in care, has great appeal to benefit the individual and to reduce HIV transmission within the community. Dr. Springer has been awarded 2 R01s (Project 1, NIDA R01 DA030762; and Project 2, R01 AA018944) that serve as the research platform for this independent scientist award. The specific aim of both studies is to conduct a placebo-controlled RCT of extended-release NTX (XR- NTX) for HIV+ prisoners with OD (project 1) and AD (project 2) who are transitioning to the community. The placebo-control methodology further strengthens any findings that should be demonstrated. HIV treatment, substance abuse, adverse side effects and HIV risk behavior outcomes will be compared in subjects within CJS in New Haven, Hartford and Springfield. This therapeutic approach has great appeal by the CJS, given the ease of monthly injections, lack of diversion, few side effects and no antagonistic philosophical concerns about its use. The strength of this proposal is that Dr. Springer is experienced in HIV, addiction and the CJS; the novel use of pharmacologic interventions to prevent relapse to OD and AD as a means to improve HIV outcomes; over 7 years of conducting research in the CJS; and the novelty of using XR-NTX for the treatment of OD and AD. These trials may demonstrate efficacy and safety, and then XR-NTX is likely to become an evidence-based intervention with released HIV+ prisoners. As such, the individual, our health care system and society have a high likelihood to benefit - especially on the reduction of HIV within the community.