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: 8323941
• 负责人: Vu Minh Quan
• 金额: $ 56.38万
• 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 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8323941
• 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; Enrollment; Ensure; Epidemic; Epidemiology; Future; General Population; Government; Guidelines; HIV; HIV Infections; HIV Seropositivity; 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; Risk; Services; Site; Social Network; Structure; Substance abuse problem; System; Telephone; Testing; Time; Training; 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; 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 PUBLIC HEALTH RELEVANCE: This proposed research is to respond to the RFA-DA-10-017. The seek, test and treat intervention being studied is designed based on epidemiologic evidence to address major issues in testing, treatment and care for Vietnam's highest HIV risk population. The intervention will be integrated into government systems for drug treatment and HIV/AIDS services and will supplement existing HIV prevention and care efforts.

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毒品使用（IDU）人群中（全国艾滋病毒流行率为20%）。虽然在扩大艾滋病毒预防和抗逆转录病毒治疗方案方面取得了相当大的进展，但注射吸毒者中艾滋病毒的高传播率仍然存在（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个戒毒中心（DTC）系统，其中大多数被拘留者（85%）是通过警察逮捕而被接纳的。在这种治疗后，71%的患者在DTC释放后6个月内重新接受阿片类药物注射。DTC代表了一个独特的机会，以确定，测试，并提供抗逆转录病毒疗法，以这一边缘化人口的一大部分。我们提出了一种干预措施，采用寻求，测试和治疗策略，为注射吸毒人群及其网络成员，通过确保高风险的个人寻求艾滋病毒检测，及时转介和维持抗逆转录病毒治疗，而艾滋病毒预防干预措施提供给许多谁测试艾滋病毒阴性，以及那些谁测试艾滋病毒阳性。干预措施将通过DTC使用CDC建议的在刑事司法环境中选择退出的常规艾滋病毒检测来寻找和检测注射吸毒者，并将寻找和检测其网络成员。艾滋病毒阳性注射吸毒者将通过一项两组随机对照试验被转介到艾滋病毒护理，以比较不同水平的护理参与对抗逆转录病毒疗法吸收、抗逆转录病毒治疗依从性和治疗结果的影响。审判的总期限将为五年。这项研究将在首都河内的所有参与DTC进行 公共卫生相关性：本拟定研究旨在响应RFA-DA-10-017。正在研究的寻求，测试和治疗干预措施是根据流行病学证据设计的，以解决越南艾滋病毒风险最高的人群在测试，治疗和护理方面的主要问题。干预措施将纳入政府的戒毒治疗和艾滋病毒/艾滋病服务系统，并将补充现有的艾滋病毒预防和护理工作。