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Community-Based Intervention at Needle Exchange Sites

针交换场所的社区干预

基本信息

批准号：
8607915
负责人：
MICHAEL S KIDORF
金额：
$ 58.95万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
1999
资助国家：
美国
起止时间：
1999-04-01 至 2017-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8607915
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

项目摘要

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）：基于社区的注射器交换计划（SEP）的参与者的注射毒品使用率超过了其他药物使用者人群中报告的水平（Wood 等人，2007 年）。我们小组之前的工作表明，结合动机和行为干预的组合方法与美沙酮治疗登记率的提高以及吸毒和其他高风险行为率的降低相关（Kidorf & Brooner，2006）。尽管如此，与其他来源转诊的患者相比，SEP 转诊的美沙酮治疗效果较差，包括较高的吸毒率和自然损耗率（Kidorf & Brooner，2006）。拟议的 5 年竞争性延续申请通过评估逐步诱导策略来改善注射器交换器进入美沙酮治疗的保留和其他结果，从而扩展了我们之前的工作。对美沙酮治疗感兴趣的阿片类药物依赖巴尔的摩换针 (BNEP) 参与者 (n = 520) 将完成一系列临床评估，并被随机分配到三个为期 3 个月的治疗诱导策略中的一个。第一种是低阈值诱导 (LTSC)，它广泛模仿临时美沙酮维持治疗（Schwartz 等人，2006 年），旨在逐步将 SEP 参与者过渡到维持治疗的日常结构，同时最大限度地接触美沙酮药物治疗。第二种是基于代金券的干预措施，利用金钱激励来加强对美沙酮给药时间表和阶梯式咨询的治疗参与度。最终条件（RSC）将使参与者接受常规的分级护理。所有情况的参与者都将在参与的最后 3 个月内接受常规的分级护理。所有参与者都将使用美沙酮（90 毫克）保持稳定，并每周进行随访，为期 6 个月。将在各种情况下使用结构化的再入院干预措施，以努力重新吸引因吸毒而离开治疗的参与者（Brooner＆Kidorf，2002）。保留、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素。这些发现将为该领域提供基于证据的策略，以优化这一重要的注射阿片类药物使用者亚群的美沙酮治疗效果。

项目成果

期刊论文数量（19）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Benefits of concurrent syringe exchange and substance abuse treatment participation.

同时更换注射器和参与药物滥用治疗的好处。

DOI：
10.1016/j.jsat.2010.11.011
发表时间：
2011
期刊：
Journal of substance abuse treatment
影响因子：
3.9
作者：
Kidorf,Michael;King,VanL;Peirce,Jessica;Kolodner,Ken;Brooner,RobertK
通讯作者：
Brooner,RobertK

Prospective risk factors for traumatic event reexposure in community syringe exchange participants.

社区注射器交换参与者再次暴露创伤事件的前瞻性危险因素。

DOI：
10.1016/j.drugalcdep.2014.02.010
发表时间：
2014-05-01
期刊：
DRUG AND ALCOHOL DEPENDENCE
影响因子：
4.2
作者：
Peirce, Jessica M.;Schacht, Rebecca L.;Brooner, Robert K.;King, Van L.;Kidorf, Michael S.
通讯作者：
Kidorf, Michael S.

Psychiatric distress, risk behavior, and treatment enrollment among syringe exchange participants.

注射器交换参与者的精神困扰、危险行为和治疗登记。

DOI：
10.1016/j.addbeh.2009.12.033
发表时间：
2010
期刊：
Addictive behaviors
影响因子：
4.4
作者：
Kidorf,Michael;King,VanL;Peirce,Jessica;Burke,Christopher;Kolodner,Ken;Brooner,RobertK
通讯作者：
Brooner,RobertK

Sexual-risk reduction following the referral of syringe exchange registrants to methadone maintenance: Impact of gender and drug use.