Heroin Cessation and Hiv Risk: A Case-Control Study

这项病例对照研究的目的是描述包括艾滋病毒感染在内的 有慢性海洛因吸毒史的人群持续戒毒的积极结果 在纽约市以种族/少数民族为主的经济困难社区内 (纽约市)。鉴于吸毒是艾滋病毒和慢性复发的主要风险因素，确定 促进持续戒毒可能是加强艾滋病毒预防和治疗努力的关键。同样不为人知的是 在短期和长期戒断后，性风险会发生什么；一个重要但未被充分研究的 对价。先前描述戒烟模式的研究仅限于以下几个方面 理由。首先，虽然关于复发和戒毒的工作已经做了很多，但关于长期戒毒的文献还很少。 长期有效停止。其次，大多数研究都是从缺少人的治疗环境中进行抽样 在没有治疗的情况下停止使用。第三，之前的研究没有调查过可能的影响 多个层面的决定因素，包括最初的停止情况(例如，监禁的影响， 家庭等)、个人层面因素的潜在影响(例如，社会支持、网络特征)以及 一个人的邻居环境(例如，药品的可获得性、艾滋病病例密度)。治疗后复发是 更常见的是在弱势社区，人们回到有吸毒线索的环境中， 然而，有一部分人坚持停止；描述导致这一点的邻居因素仍然存在 未得到充分研究。为了确定与持续戒烟相关的因素，我们将招募1800名海洛因使用 利用场地和受访者驱动的抽样在纽约市36个社区进行调查的个人。合资格的个人 被调查者年龄为27岁，面谈前至少有五年海洛因吸毒史。符合条件且 同意的参与者将接受结构化面试，包括对之前6年的逐年召回 正如在早期研究中成功使用的那样。为了进行分析，病例将被定义为前海洛因吸毒者， 即面试时不使用(N=744)。设两个对照组：(1)连续吸食海洛因者 在过去六年中，(N=527)和(2)在过去5年中某个时间戒毒的海洛因复吸者 数年，但后来又吸毒(N=527)。病例(持续戒断)和对照将是 在分析过程中，年龄和开始吸食海洛因的年龄(2岁)相匹配的频率。持续的决定因素 戒烟将使用条件Logistic回归和分层建模进行评估。来自于此的数据 研究可以用来确定可能受到个人、团体或政策影响的可修改因素 促进持续戒除鸦片类药物使用的干预措施。此外，我们将考虑戒除海洛因 通过研究戒烟和高危性行为之间的关系，将其作为一种“暴露”。

The purpose of this case-control study is to characterize the prognostic indicators, including HIV infection, for the positive outcome of sustained heroin cessation among persons with a prior history of chronic heroin use within economically disadvantaged, predominantly racial/ethnic minority neighborhoods in New York City (NYC). With drug use as a major risk factor for HIV and a chronic relapsing condition, identifying factors that promote sustained cessation can be key to enhancing HIV prevention and treatment efforts. Also unknown is what happens with sexual risk after short and long term cessation; an important but understudied consideration. Previous studies that have described patterns of cessation have been limited for several reasons. First, while much work has been done on relapse and cessation, the literature is sparse on long- term effective cessation. Second, most studies have sampled from treatment settings which misses persons who cease use without treatment. Third, previous research has not investigated the possible impact of determinants at multiple levels, including initial circumstances of cessation (e.g., influence of incarceration, family, etc.), potential influences of individual-level factors (e.g., social support, network characteristics) and one's neighborhood context (e.g., availability of drugs, density of AIDS cases). Post treatment relapse is more common in disadvantaged communities where persons return to settings with cues for druguse, however a proportion sustains cessation; characterizing neighborhood factors that contribute to this remains understudied. To identify factors associated with sustained cessation, we will recruit 1800 heroin using individuals utilizing venue- and respondent-driven sampling in 36 NYC neighborhoods. Eligible individuals will be those aged >27 years with a history of heroin use at least five years before interview. Eligible and consenting participants will undergo structured interviews include a year by year recall for the prior 6 years as has been used successfully in earlier studies. For analyses, cases will be defined as former heroin users, i.e., non-use at interview (N=744). Two control groups are specified: (1) heroin users who used continuously through past six years, (N=527) and (2) relapsed heroin users who were abstinent sometime in the past 5 years but who subsequently relapsed to drug use (N=527). Cases (sustained cessation) and controls will be frequency matched on age and age at heroin initiation (¿2 years) during analysis. Determinants of sustained cessation will be assessed using conditional logistic regression and hierarchical modeling. Data from this study can be used to identify modifiable factors that can be subjected to individual, group or policy intervention to promote sustained cessation from opiate use. Additionally, we will consider heroin cessation as an "exposure" by examining the relation between cessation and high-risk sexual behavior.