Efficacy of Drug-HIV counseling among IDU at Methadone clinics in Jakarta

雅加达美沙酮诊所注射吸毒者药物艾滋病毒咨询的效果

• 批准号: 7835556
• 负责人: DAVID S METZGER
• 金额: $ 31.44万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-15 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7835556
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Asia; Asians; Behavior; Behavior Therapy; Behavioral; China; Clinic; Cognitive; Collaborations; Cost-Benefit Analysis; Costs and Benefits; Counseling; Country; Data; Development; Doctor of Philosophy; Drug Addiction; Drug Costs; Drug abuse; Drug usage; Drug user; Economics; Enrollment; Environment; Epidemic; Equipment; Fellowship; HIV; HIV Infections; Heroin; Heroin Users; Hospitals; Individual; Indonesia; Informed Consent; Injecting drug user; Injection of therapeutic agent; Intervention; Laboratories; Malaysia; Manuals; Measures; Methadone; National Institute of Drug Abuse; Opiate Addiction; Opiates; Participant; Patients; Pennsylvania; Pharmaceutical Preparations; Population; Prevalence; Procedures; Randomized; Recruitment Activity; Relative (related person); Research; Research Personnel; Risk; Risk Assessment; Risk Behaviors; Risk Reduction; Structure; System; Testing; Time; Universities; Urinalysis; Work; arm; cost; cost effective; design; drug efficacy; evidence base; experience; follow-up; group intervention; methadone clinic/center; methadone maintenance; programs; prospective; public health relevance; randomized trial; response; scale up; sex risk; standard care; tool; treatment as usual

DESCRIPTION (provided by applicant): According to UNAIDS, Indonesia is experiencing one of the most rapidly expanding HIV/AIDS epidemics in Asia. The epidemic in Indonesia has been fueled by injection drug use among heroin users and the national response includes the scale-up of methadone maintenance treatment. Drug counseling is considered to be an integral part of methadone treatment, but few studies have been designed to assess its benefits and costs. In settings such as Jakarta, data regarding the costs and benefits of drug counseling have critical public heath relevance. We propose to conduct a prospective randomized trial to evaluate the efficacy of integrated drug and HIV counseling among injecting drug users. This study will be conducted at six methadone clinics in Jakarta, Indonesia where the HIV prevalence among injecting drug users ranges between 50- 86%, with collaborators from the Drug Dependence Hospital in Jakarta, the University of Pennsylvania and Yale University. The specific aims of this four year study are to evaluate the impact of Behavioral Drug and Risk Counseling (BDRC)-a low intensity, cognitive behavioral approach that integrates drug counseling and risk reduction intervention. Those assigned to the BDRC arm will be compared to those who receive treatment as usual which includes an initial risk reduction intervention and counseling as needed. We hypothesize that the structured, low intensity BDRC approach will be more cost effective and result in higher rates of retention in treatment, lower rates of drug use and lower rates of HIV risk. To test these hypotheses, the research team in Jakarta will recruit 300 injecting drug users as they enter treatment at the Drug Dependence Hospital and its five satellite programs. Following informed consent procedures, research staff will randomize participants to either the BDRC intervention or to treatment as usual. All subjects will be fuly assessed at baseline and months 3, 6, 9, and 12. The proposed work will be build on collaborations that have been established with the Indonesian Investigator Adhi Nurhidayat,MD during his NIDA INVEST Fellowship at University of Pennsylvania when he spent time with David Metzger, PhD and George Woody, MD. It will also extend findings from a WHO study on substitution therapy of opiates and HIV/AIDS that was completed by Riza Sarasvita, MS,MHS (former NIDA Humphrey Fellow at Johns Hopkins University) and her colleagues at The Drug Dependence Hospital Jakarta-Indonesia. PUBLIC HEALTH RELEVANCE: The AIDS epidemic in Indonesia has been fueled by injection drug use among heroin users and the National response includes the scale-up of methadone maintenance treatment. Drug counseling is considered to be an integral part of methadone treatment, but few studies have been designed to assess its benefits and costs. In settings such as Jakarta, data regarding the costs and benefits of integrated drug and risk counseling have critical public heath relevance.

描述（由申请人提供）：据联合国艾滋病规划署称，印度尼西亚正在经历亚洲艾滋病毒/艾滋病蔓延最快的流行病之一。印度尼西亚的这一流行病因海洛因使用者注射毒品而加剧，国家应对措施包括扩大美沙酮维持治疗。药物咨询被认为是美沙酮治疗的一个组成部分，但很少有研究被设计来评估其效益和成本。在雅加达这样的环境中，有关药物咨询的成本和收益的数据具有重要的公共卫生相关性。我们建议进行一项前瞻性随机试验，以评估注射毒品使用者的药物和艾滋病综合咨询的效果。这项研究将在印度尼西亚雅加达的六个美沙酮诊所进行，注射毒品使用者的艾滋病毒流行率在50- 86%之间，合作者来自雅加达药物依赖医院，宾夕法尼亚大学和耶鲁大学。这项为期四年的研究的具体目标是评估行为药物和风险咨询（BDRC）的影响-一种低强度，认知行为方法，将药物咨询和降低风险干预相结合。分配到BDRC组的患者将与正常接受治疗的患者进行比较，其中包括根据需要进行初始风险降低干预和咨询。我们假设，结构化的，低强度的BDRC方法将更具成本效益，并导致更高的保留率在治疗中，更低的药物使用率和更低的艾滋病毒风险率。为了验证这些假设，雅加达的研究小组将招募300名在药物依赖医院及其五个卫星项目接受治疗的注射毒品使用者。在知情同意程序之后，研究人员将参与者随机分配至BDRC干预或常规治疗。将在基线和第3、6、9和12个月时对所有受试者进行全面评估。拟议的工作将建立在与印度尼西亚研究员Adhi Nurhidayat博士在宾夕法尼亚大学NIDA INVEST奖学金期间与大卫梅茨格博士和乔治伍迪博士一起度过的合作基础上。它还将扩展由Riza Sarasvita，MS，MHS（约翰霍普金斯大学前NIDA Humphrey研究员）及其在印度尼西亚雅加达药物依赖医院的同事完成的世卫组织关于阿片类药物替代疗法和艾滋病毒/艾滋病的研究结果。公共卫生关系：印度尼西亚的艾滋病流行因海洛因使用者注射毒品而加剧，国家应对措施包括扩大美沙酮维持治疗。药物咨询被认为是美沙酮治疗的一个组成部分，但很少有研究被设计来评估其效益和成本。在雅加达这样的环境中，关于综合药物和风险咨询的成本和效益的数据具有关键的公共卫生相关性。