Testing a Community-Friendly Risk Reduction Intervention for Injection Drug Users

描述（由申请人提供）：尽管有一系列广泛的艾滋病预防方法和相关研究，但在美国，十年来每年有40,000例新的艾滋病诊断（CDC, 2004；哥本哈根和费舍尔，出版中）。注射吸毒者仍然是目标人群，因为他们是新发艾滋病毒感染的重要传播媒介（Avants等人，2004年；Margolin等人，2003年），这些感染是通过可预防的与药物和性有关的艾滋病毒风险行为发生的。一些以证据为基础的减少艾滋病毒风险干预措施现已作为一整套干预措施广泛提供。然而，很少有基于证据的干预措施被设计用于在普通药物治疗cbo中实施，例如美沙酮维持计划（MMPs），许多高风险吸毒者寻求治疗。此外，基于传播治疗药物依赖的循证行为干预措施的类似努力（Morgenstern等人，2001年；医学研究所，1998年），少数适用于药物治疗CBOs的循证干预措施的设计并非“社区友好”，因此不太可能按预期实施或在这些关键环境中持久。我们的调查小组开发了一个大大缩短的、社区友好的、基于证据的全面健康恢复方案（HHRP； Avants等人，2004年；Margolin等人，2003年）。缩短版的“社区友好型健康恢复计划”（CHRP）已在资源有限的药物治疗CBO内的一项非对照研究中证明了可行性和可接受性，以及有效性的初步证据（哥本哈根等人，已出版；见附录）。在这个修订后的R01申请中，我们建议在随机对照试验（RCT）中评估CHRP。如果在拟议的试验中被发现是有效的，CHRP就有可能按照设计完全整合到许多其他资源有限的cbo中，在这些cbo中有大量高风险吸毒者参与药物治疗。

DESCRIPTION (provided by applicant): Despite a wide array of HIV prevention approaches and related research, there is a decade-long trend of 40,000 new HIV diagnoses per year in the U.S. (CDC, 2004; Copenhaver & Fisher, in press). Injection drug users (IDUs) remain a target population as they represent a significant vector for the transmission of new HIV infections (Avants et al., 2004; Margolin et al., 2003), which occur through preventable drug- and sex- related HIV risk behaviors. A number of evidence-based HIV risk reduction interventions are now widely available as complete intervention packages. However, very few evidence-based interventions have been designed for implementation within common drug treatment CBOs, such as methadone maintenance programs (MMPs), where many high-risk drug users seek treatment. Moreover, based on analogous efforts to disseminate evidence-based behavioral interventions for treating drug dependence (Morgenstern et al., 2001; Institute of Medicine, 1998), the few evidence-based interventions that are applicable to drug treatment CBOs are not designed to be "community-friendly" and are therefore unlikely to be implemented as intended or durable within these critical settings. Our team of investigators has developed a significantly shortened, community-friendly, version of the comprehensive evidence-based Holistic Health Recovery Program (HHRP; Avants et al., 2004; Margolin et al., 2003). The shortened version, the Community-friendly Health Recovery Program (CHRP), has demonstrated feasibility and acceptability as well as preliminary evidence of effectiveness in an uncontrolled study within a resource-limited drug treatment CBO (Copenhaver et al., in press; see Appendix). In this revised R01 application, we propose to evaluate CHRP in a randomized controlled trial (RCT). If found to be effective in the proposed trial, CHRP has the potential to be fully integrated, as designed, within many other resource-limited CBOs where large numbers of high risk drug users participate in drug treatment.