Seek, Test, Treat Strategies for Vietnamese Drug Users: A Random Controlled Trial

越南吸毒者的寻求、测试、治疗策略：随机对照试验

• 批准号: 8722523
• 负责人: Vu Minh Quan
• 金额: $ 61.83万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8722523
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Affect; Analgesics; Anti-Retroviral Agents; Bar Codes; CD4 Lymphocyte Count; Capital; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Clinic; Counseling; Criminal Justice; DA10; Drug Metabolic Detoxication; Drug Rehabilitation Centers; Drug usage; Drug user; Education; Enrollment; Ensure; Epidemic; Epidemiology; Future; General Population; Government; Guidelines; HIV; HIV Infections; HIV Seropositivity; HIV risk; HIV-1; Health; Health Services Accessibility; Heroin; Human immunodeficiency virus test; Incentives; Incidence; Individual; Injecting drug user; Injection of therapeutic agent; Intervention; Lead; Manuals; Methadone; Network-based; Opioid; Outcome Measure; Participant; Patient Self-Report; Pharmaceutical Preparations; Police; Population; Prevalence; Prevention therapy; Preventive Intervention; Principal Investigator; Public Health; Quality of life; RNA; Randomized; Randomized Controlled Trials; Regimen; Relapse; Research; Research Infrastructure; Services; Site; Social Network; Structure; Substance abuse problem; System; Telephone; Testing; Time; Treatment outcome; Vietnam; Vocational Education; addiction; antiretroviral therapy; arm; authority; base; career; control trial; cost effectiveness; design; directly administered antiretroviral therapy; experience; follow-up; high risk; improved; injection drug use; male; meetings; member; methadone clinic/center; mortality; novel; outreach; primary outcome; programs; prospective; secondary outcome; standard care; therapy adherence; transmission process; uptake; voucher

DESCRIPTION (provided by applicant): Injection heroin use and HIV/AIDS are major public health problems in Vietnam, with HIV infection continuing to be concentrated among the growing injection drug use (IDU) population (20% HIV prevalence, nationally). Although considerable progress has been made to expand HIV prevention and antiretroviral therapy (ART) programs, the high HIV transmission rate among IDUs continues (HIV incidence, 5% per year), access to antiretroviral therapy still limited (11%), and mortality among HIV-positive drug users remains excessive (15% per year), requiring interventions. The Vietnamese government's approach to drug demand reduction has primarily relied on its system of 83 drug treatment centers (DTC) where most detainees (85%) are admitted through arrests by police. Relapse to opioid injection after such treatment is 71% within 6 months after release from DTCs. DTCs represent a unique opportunity to identify, test, and provide ART to a large segment of this marginalized population. We propose an intervention that employs the seek, test, and treat strategies for the IDU population and their network members, by ensuring that high risk individuals are sought for HIV testing, promptly referred to and maintained on ART, while HIV prevention interventions provided to the many who test HIV-negative, as well as those who test HIV-positive. The intervention will seek and test IDUs via DTCs using CDC-recommended routine opt-out HIV testing in criminal justice settings and also will seek and test their network members. HIV-positive IDUs will be referred to HIV care through a two arm randomized controlled trial to compare the effects of different levels of engagement in care on ART uptake, antiretroviral adherence, and treatment outcome. The total duration of the trial will be five years. The study will be conducted in all participating DTCs in the capital city of Hanoi

描述（由申请人提供）：注射海洛因使用和艾滋病毒/艾滋病是越南的主要公共卫生问题，艾滋病毒感染继续集中在不断增长的注射吸毒 (IDU) 人群中（全国艾滋病毒感染率为 20%）。尽管在扩大艾滋病毒预防和抗逆转录病毒治疗（ART）计划方面取得了相当大的进展，但注射吸毒者中艾滋病毒传播率仍然很高（艾滋病毒发病率，每年 5%），获得抗逆转录病毒治疗的机会仍然有限（11%），艾滋病毒阳性吸毒者的死亡率仍然过高（每年 15%），需要采取干预措施。越南政府减少毒品需求的方法主要依靠其 83 个戒毒治疗中心 (DTC) 系统，大多数被拘留者 (85%) 通过警察逮捕而入院。在 DTC 释放后 6 个月内，此类治疗后阿片类药物注射复发的比例为 71%。 DTC 代表了一个独特的机会，可以为这一边缘人群识别、测试和提供 ART。我们建议采取针对注射吸毒者群体及其网络成员的寻找、检测和治疗策略的干预措施，确保寻找高危人群进行艾滋病毒检测，及时转诊并维持抗逆转录病毒疗法，同时向许多艾滋病毒检测呈阴性和艾滋病毒检测呈阳性的人提供艾滋病毒预防干预措施。该干预措施将通过 DTC 使用 CDC 推荐的刑事司法环境中的常规选择退出艾滋病毒检测来寻找和测试注射吸毒者，并将寻找和测试其网络成员。 HIV 阳性注射吸毒者将通过一项两组随机对照试验转介至 HIV 护理，以比较不同护理参与程度对 ART 接受、抗逆转录病毒治疗依从性和治疗结果的影响。试验的总持续时间为五年。该研究将在首都河内所有参与的 DTC 中进行