COMMUNITY BASED INTERVENTION AT NEEDLE EXCHANGE SITES

针头交换方案旨在为注射吸毒者提供随时可用的无菌针头和注射器，以减少共用受污染设备的频率，从而降低传播艾滋病毒和其他血液传播疾病的风险。大多数项目还建议参与者不要继续吸毒，并为那些要求戒毒的人提供药物滥用治疗转诊，但只有少数人真正转诊接受治疗。拟议的为期3年的研究将系统地评估一种有前景的社区干预措施，以鼓励阿片类药物滥用者参加治疗。巴尔的摩市针头交换计划（n=1011）的新登记者将首先评估物质使用率和其他精神诊断，物质使用和社会心理问题的严重程度，以及艾滋病毒药物使用和性风险的严重程度。符合美沙酮条件的患者（n=807）将被随机分配到三种治疗转诊策略中的一种：1)自我转诊（SR），2)动机增强（ME）和3)注意控制（AC）。SR参与者如有兴趣转介治疗，应自行联系常规针头交换人员；这种策略是通常的程序。ME参与者将接受结构化的动机访谈，强调参与治疗的好处和后果（Miller and Rollnick, 1991），然后要求他们表明他们对转诊治疗的兴趣。注意力控制转介组（AC）将通过让参与者参加工作准备面试，然后询问他们是否对治疗转介感兴趣，来控制与ME参与者相处的时间。所有要求药物滥用治疗的参与者将进入治疗转诊行动阶段，在此过程中接受非美沙酮治疗（如果要求）或美沙酮治疗时段专门用于针头交换计划（n=250）。主要依赖指标为：1)每种疾病中要求转诊治疗的参与者比例；2)进入治疗的参与者比例。所有研究参与者将在注册后进行10-16个月的随访（取决于他们是否和何时进入治疗），以确定交换计划的使用（即参加治疗的天数和注射器交换）；在接受治疗的患者中，保留率也将确定。提出的研究将提供新的和重要的信息，关于新的针头交换登记者的问题特征。这些数据也将用于预测对转诊干预措施的反应。在这项研究中评估的动机干预是一个合乎逻辑的下一步，以加强大多数针头交换计划已经取得的令人印象深刻的公共卫生效益。重要的是，这种干预可以很容易地纳入大多数交流项目的常规做法。

Needle exchange programs were designed to provide injection drug users with ready access to sterile needles and syringes to reduce the frequency of sharing contaminated equipment and thereby lower the risk of transmitting HIV and other blood borne diseases. Most programs also counsel participants against continued drug use and offer drug abuse treatment referrals to those who request one, but only a minority actually pursue referral into treatment. The proposed 3-year study will systematically evaluate a promising community-based intervention for encouraging opiate abusers to enroll in treatment. New registrants at the Baltimore City Needle Exchange Program (n=1011) will be first assessed for rates of substance use and other psychiatric diagnoses, severity of substance use and psychosocial problems, and HIV drug use and sexual risk severity. Those who are methadone eligible (n=807) will be randomly assigned to one of three treatment referral strategies: 1) self-referral (SR),2) motivational enhancement (ME), and 3) attention control (AC). SR participants will contact routine needle exchange staff on their own about any interest in a treatment referral; this strategy is the usual procedure. ME participants will be administered a structured motivational interview highlighting the benefits and consequences of treatment participation (Miller and Rollnick, 1991) and then asked to indicate their interest in a referral to treatment. An attention control referral group (AC) will control for time spent with ME participants by engaging participants in a job readiness interview and then asking if they are interested in a treatment referral. All participants requesting drug abuse treatment will move to a treatment referral action phase enroute to admission to non-methadone (if requested) or methadone treatment slots dedicated to the needle exchange program (n=250). The primary dependent measures are: 1) proportion of participants in each condition who request a treatment referral; 2) proportion of participants who enter treatment. All study participants will be followed for 10-16 months (depending on if and when they entered treatment) following registration to determine use of the exchange program (i.e., number of days attended and syringe exchanges); retention rates will also be determined in those who enter treatment. The proposed study will provide new and important information on the problem characteristics of new needle exchange enrollees. This data will also be used to predict response to the referral interventions. The motivational intervention evaluated in this study is a logical next step to strengthen the impressive public health benefits already achieved by most needle exchange programs. Importantly, this intervention can be easily incorporated as routine practice in most exchange programs.