Heroin Cessation and Hiv Risk: A Case-Control Study

海洛因戒断和艾滋病毒风险：病例对照研究

• 批准号: 8055105
• 负责人: DAVID VLAHOV
• 金额: $ 5.12万
• 依托单位: NEW YORK ACADEMY OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-20 至 2011-02-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8055105
• 关键词: AIDS prevention; Abstinence; Acquired Immunodeficiency Syndrome; Aftercare; Age; Age-Years; Awareness; Case-Control Studies; Censuses; Characteristics; Child; Chronic; Cities; Cocaine; Communities; Consent; Control Groups; Counseling; Criminal Justice; Cues; Data; Disadvantaged; Drug Metabolic Detoxication; Drug abuse; Drug usage; Economically Deprived Population; Epidemiology; Ethnic Origin; Ethnography; Event; Factor Analysis; Family; Frequencies; Goals; HIV; HIV Infections; Heroin; Heroin Users; Human immunodeficiency virus test; Imprisonment; Incidence; Individual; Injection of therapeutic agent; Intervention; Interview; Jamaica; Libido; Life; Literature; Location; Logistic Regressions; Long Island; Maps; Marital Status; Medical; Methadone; Methods; Minority Groups; Modeling; Narcotics; Natural History; Neighborhoods; New York City; Opiates; Opioid; Outcome; Overdose; Participant; Patient Self-Report; Pattern; Persons; Pharmaceutical Preparations; Policies; Population; Race; Recording of previous events; Recovery; Recruitment Activity; Relapse; Replacement Therapy; Reporting; Research; Research Personnel; Respondent; Risk; Risk Factors; Risk Reduction; Route; Sampling; Services; Sexual Partners; Social support; Specific qualifier value; Structure; System; Techniques; Testing; Therapeutic; Time; Unsafe Sex; Urine; Visit; Work; base; case control; demographics; density; experience; high risk sexual behavior; land use; outreach; prognostic; prognostic indicator; programs; segregation; sex; sex risk; success

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.

本病例对照研究的目的是描述预后指标，包括 HIV 感染， 有长期吸食海洛因史的人持续戒除海洛因的积极成果 纽约市经济弱势、以种族/族裔为主的社区内 （纽约）。由于吸毒是艾滋病毒和慢性复发性疾病的主要危险因素，因此应确定以下因素： 促进持续戒烟可能是加强艾滋病毒预防和治疗工作的关键。还未知的是 短期和长期戒烟后性风险会发生什么？一个重要但尚未得到充分研究的 考虑。先前描述戒烟模式的研究仅限于一些研究 原因。首先，虽然在复发和戒烟方面已经做了很多工作，但长期研究的文献却很少。 期限有效停止。其次，大多数研究都是从遗漏人员的治疗环境中抽样的 未经治疗即停止使用的人。第三，之前的研究并没有调查可能的影响。 多个层面的决定因素，包括戒烟的初始情况（例如监禁的影响、 家庭等）、个体层面因素（如社会支持、网络特征）的潜在影响以及 一个人的社区环境（例如，药物的供应情况、艾滋病病例的密度）。治疗后复发是 在弱势社区更为常见，人们返回有吸毒线索的环境， 但仍有一部分人继续戒烟；描述造成这一现象的邻里因素仍然存在 待研究。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 个人在纽约市 36 个社区利用场地和受访者驱动的抽样。符合资格的个人 年龄 >27 岁，在面试前至少五年有海洛因吸食史。符合资格且 同意的参与者将接受结构化访谈，包括逐年回忆过去 6 年的情况 正如在早期研究中已成功使用的那样。为了进行分析，病例将被定义为前海洛因使用者， 即面试时不使用（N=744）。指定了两个对照组：（1）连续吸食海洛因的使用者 过去六年中，(N=527) 和 (2) 过去 5 年间曾戒毒的海洛因复吸者 数年但随后再次吸毒（N=527）。病例（持续戒烟）和控制措施将 分析期间，频率与年龄和海洛因吸食年龄（2 岁）相匹配。持续的决定因素 将使用条件逻辑回归和分层模型来评估戒烟情况。数据来自于此 研究可用于识别可修改的因素，这些因素可能受到个人、团体或政策的影响 促进持续戒除阿片类药物使用的干预措施。此外，我们将考虑戒除海洛因 通过检查戒烟和高风险性行为之间的关系来作为“暴露”。