A Pilot Implementation Project of Methadone and Suboxone for Injecting Drug Users

注射吸毒者使用美沙酮和赛博松试点项目

• 批准号: 9059930
• 负责人: CHARLES P O'BRIEN
• 金额: $ 1.76万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9059930
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Anti-Retroviral Agents; Area; Asia; Awareness; Behavioral; Buprenorphine; Caring; Cities; Clinic; Clinical Research; Collaborations; Communities; Cost Measures; Costs and Benefits; Counseling; Country; Data; Dose; Drug abuse; Drug usage; Drug user; Employment; Enrollment; Epidemic; Evaluation; Frequencies; Goals; HIV; HIV Infections; HIV Seropositivity; Health; Heroin; High Prevalence; Highly Active Antiretroviral Therapy; Hospitals; Improve Access; Incidence; Individual; Infection; Injecting drug user; Literature; Measures; Methadone; Modeling; Monitor; Naloxone; Opiates; Outcome; Participant; Patients; Pennsylvania; Perception; Pharmaceutical Preparations; Population; Prevention; Prevention Measures; Prevention program; Protocols documentation; Province; Qualitative Methods; Research; Research Personnel; Resources; Risk; Risk Behaviors; Services; Source; Structure; System; Testing; Therapeutic; Time; Training Programs; Universities; Vietnam; Viral; Viral Load result; Work; addiction; base; criminal behavior; experience; implementation research; improved; injection drug use; intravenous drug use; medication compliance; methadone maintenance; outreach; programs; scale up; solidarity; substance abuse treatment; success; treatment program; treatment strategy

DESCRIPTION (provided by applicant): HIV continues to spread around the world and new infections in Asia are one of the most important areas for prevention among drug using populations. There is strong and consistent evidence from several countries that while injection drug users (IDU) continue to be a source of new infections, treatment of opiae addiction is an effective prevention measure against further spread. Among those IDU already infected, substance abuse treatment can improve access and adherence to HAART therapy and promote sustained viral suppression. The proposed project will take place at the Go Vap HIV clinic in Ho Chi Minh City (HCMC), Vietnam. Vietnam is an original PEPFAR country and has experienced a major HIV epidemic that has been propelled by injection drug use. In HCMC, it is now estimated that 51.8% of injection drug users (IDU) are HIV positive. While the country has begun the scale up of methadone maintenance treatment (MMT), coverage remains inadequate and the rate of expansion of new treatment programs clearly needs to be accelerated in order to have meaningful impact on the epidemic. For heroin (and other opiate) dependent individuals, methadone maintenance has limited availability and there are currently no buprenorphine/naloxone (Suboxone) treatment programs in Vietnam. This newer medication has the possibility of making treatment available to more patients because of the efficiency of three times per week dosing and, given the high prevalence of HIV among drug users in HCMC, fewer interactions with antiretroviral medications. These factors motivated the Provincial AIDS Committee of HCMC to seek support in expanding drug treatment to both HIV positive and negative IDUs as a model prevention program. These discussions have led to the current proposal that will begin with the implementation of a comprehensive training program on addiction and medication assisted treatment (MAT). Following this training the program will introduce MMT at the Go Vap clinic. In the second year, daily methadone will continue to be available and selected patients will be given the opportunity to be treated with Suboxone progressing from daily to thrice weekly observed treatment. All participants also will be engaged in behavioral drug and risk counseling. During the course of the project we project enrolling 300 IDUs (150 HIV + and 150 HIV-) into MAT treatment program co-located with the Go VAP clinic. We are not proposing a comparison between methadone and Suboxone. Both are safe and effective medications. We will demonstrate feasibility and evaluate participant, clinic, and community factors that promote or inhibit program implementation. We will measure costs and identify factors that are associated with treatment success for each medication and for positive and negative participants. Importantly, the program is being implemented in partnership with the Provincial AIDS Committee of HCMC and will contribute to their goal of expanding access to both drug abuse and HIV treatment.

描述（由申请人提供）：艾滋病毒继续在世界范围内传播，亚洲的新感染病例是预防吸毒人群中最重要的领域之一。来自若干国家的有力和一致的证据表明，虽然注射吸毒者仍然是新感染的一个来源，但治疗阿片成瘾是防止进一步传播的有效预防措施。在那些已经感染了IDU的人中，药物滥用治疗可以改善HAART治疗的可及性和依从性，并促进持续的病毒抑制。拟议的项目将在越南胡志明市（HCMC）的Go Vap艾滋病诊所进行。越南是总统防治艾滋病紧急救援计划的最初实施国，由于注射毒品的使用，越南经历了一次严重的艾滋病毒流行。在胡志明市，目前估计51.8%的注射吸毒者（IDU）是艾滋病毒阳性。虽然该国已开始扩大美沙酮维持治疗的规模，但覆盖率仍然不足，显然需要加快扩大新治疗方案的速度，以便对这一流行病产生有意义的影响。对于海洛因（和其他阿片类药物）依赖的个体，美沙酮维持的可用性有限，目前在越南没有丁丙诺啡/纳洛酮（Suboxone）治疗方案。由于每周给药三次的有效性，这种较新的药物有可能使更多的患者获得治疗，并且鉴于HCMC吸毒者中艾滋病毒的高流行率，与抗逆转录病毒药物的相互作用较少。这些因素促使胡志明市省艾滋病委员会寻求支持，将药物治疗扩大到艾滋病毒阳性和阴性注射吸毒者，作为一个模范预防方案。这些讨论导致了目前的提案，该提案将从实施一项关于成瘾和药物辅助治疗（MAT）的综合培训计划开始。在这次培训之后，该项目将在Go Vap诊所介绍MMT。在第二年，每日美沙酮将继续可用，选定的患者将有机会接受苏博松治疗，从每日到每周观察治疗三次。所有参与者还将参与行为药物和风险咨询。在项目过程中，我们计划将300名idu（150名HIV +和150名HIV-）纳入与Go VAP诊所位于同一地点的MAT治疗计划。我们不建议比较美沙酮和苏博松。两者都是安全有效的药物。我们将论证可行性，并评估促进或抑制项目实施的参与者、诊所和社区因素。我们将衡量成本，并确定与每种药物以及阳性和阴性参与者的治疗成功相关的因素。重要的是，该方案正在与胡志明市省艾滋病委员会合作实施，并将有助于实现其扩大获得药物滥用和艾滋病毒治疗的目标。