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， 在有慢性海洛因使用史的人中持续停止海洛因的积极结果 在纽约市经济上处于不利地位的、主要是种族/少数民族的社区内 （NYC）.鉴于吸毒是艾滋病毒的一个主要风险因素，也是一种慢性复发性疾病， 促进持续戒烟是加强艾滋病毒预防和治疗工作的关键。同样未知的是 在短期和长期停止后，性风险会发生什么;一个重要但未充分研究的问题， 考虑.先前描述戒烟模式的研究仅限于几个 原因首先，虽然已经做了很多工作复发和停止，文献是稀疏的长期- 有效终止。其次，大多数研究都是从治疗环境中取样， 停止使用而不治疗。第三，以前的研究没有调查可能的影响， 多层次的决定因素，包括停止的初始情况（例如，监禁的影响， 家庭等），个体水平因素的潜在影响（例如，社会支持，网络特征）和 一个人的邻近环境（例如，药物供应、艾滋病病例密度）。治疗后复发是 在人们返回有吸毒线索的环境的弱势社区更为常见， 然而，有一部分维持停止;有助于这一点的特征性邻里因素仍然存在 替补演员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 个人利用场地和响应驱动的采样在36个纽约市社区。符合条件的个人 将是那些年龄>27岁，在面试前至少五年有海洛因使用史的人。有资格和 同意的参与者将接受结构化访谈，包括前6年的逐年回忆 正如在早期研究中成功使用的那样。为了进行分析，将把病例定义为前海洛因使用者， 也就是说，在访谈时未使用（N=744）。两个对照组被指定：（1）海洛因使用者连续使用 在过去6年中，（N=527）和（2）在过去5年中某个时候戒断的复吸海洛因使用者 年，但随后复发的药物使用（N=527）。病例（持续停药）和对照组将 在分析期间，与年龄和开始使用海洛因时的年龄（约2岁）相匹配的频率。持续的决定因素 将使用条件逻辑回归和分层模型评估戒烟。数据从该 研究可用于确定可受个人、团体或政策影响的可变因素 干预以促进持续停止使用阿片类药物。另外，我们会考虑停止吸食海洛因 作为一种“暴露”，通过检查停止和高风险性行为之间的关系。