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: 8146195
• 负责人: Vu Minh Quan
• 金额: $ 57.23万
• 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/8146195
• 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(申请人提供)：注射海洛因和艾滋病毒/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日益增长的注射吸毒(IDU)人口中(全国艾滋病毒流行率为20%)。尽管在扩大艾滋病毒预防和抗逆转录病毒疗法(ART)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%)，需要干预。越南政府减少毒品需求的方法主要依赖于其83个戒毒中心(DTC)的系统，在那里，大多数被拘留者(85%)是通过警方逮捕的方式被接纳的。阿片类药物治疗后6个月内复发率为71%。DTC代表着一个独特的机会，可以识别、测试并向这一边缘人群中的很大一部分人提供ART。我们建议对注射吸毒者及其网络成员采取寻求、检测和治疗战略，确保寻求高危人群进行艾滋病毒检测，及时转介并维持抗逆转录病毒疗法，同时向许多艾滋病毒检测阴性的人和艾滋病毒阳性者提供艾滋病毒预防干预。这项干预将通过疾病预防控制中心在刑事司法环境中使用疾控中心建议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阳性的注射吸毒者将通过一项双臂随机对照试验被转介到HIV护理，以比较不同护理水平对ART摄取率、抗逆转录病毒依从性和治疗结果的影响。审判的总期限为五年。这项研究将在首都河内的所有参与的数字技术中心进行 公共卫生相关性：这项拟议的研究是对RFA-DA-10-017的回应。正在研究的寻求、检测和治疗干预措施是基于流行病学证据设计的，旨在解决越南艾滋病毒最高风险人群的检测、治疗和护理方面的主要问题。这项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。