HIV Risk Reduction and Drug Abuse Treatment in Malaysia

描述（由申请人提供）：结合药物滥用和艾滋病毒风险 阿片类激动剂维持治疗（OMT）减量咨询，或 用纳洛酮（NMT）进行拮抗剂维持治疗， 减少非法药物使用和预防与吸毒有关的艾滋病毒传播 海洛因依赖，但对NMT的支持仍然薄弱，OMT目前没有 在许多西太平洋国家都有（例如，马来西亚、印度尼西亚和 新加坡）海洛因成瘾和艾滋病毒感染流行， 与注射毒品使用（IDU）和高风险性行为有关， 瘾君子NMT在马来西亚的可喜成果引起了人们对以下方面的兴趣： 使用丁丙诺啡（BMT）评估OMT，并比较 单独咨询和咨询与BMT或NMT相结合。我们建议 为期24周的随机双盲临床试验，以评估 保持禁欲和减少艾滋病毒的危险行为的手册指导，艾滋病毒 风险降低和药物咨询（DC-HIV）单独使用或与BMT联合使用， NMT适用于最近戒毒和目前戒断的海洛因依赖患者 （N= 180）在马来西亚（具体目标1）。该研究将允许评估3个 假设：DC-HIV+纳洛酮上级优于DC-HIV单药; DC-HIV + 丁丙诺啡上级优于单独的DC-HIV; DC-HIV加纳洛酮 上级于DC-HIV加丁丙诺啡。主要结局指标，评估依据 每周3次尿液毒理学检测和自我报告，包括恢复海洛因 使用，1或3周连续复发和减少艾滋病毒的危险行为。的 该项目还将评估寻求治疗的海洛因的特征 马来西亚的吸毒者（包括特定的风险行为和艾滋病毒风险模式 行为;精神病和其他医学合并症的患病率;以及 社会、家庭、职业和犯罪活动和服务的模式 需求-具体目标2）。这些数据将用于修订DC-HIV手册， 解决马来西亚海洛因的具体情况和危险行为 瘾君子最后，该项目还将提供卫生临床培训， 药物滥用治疗和艾滋病毒方面的专业人员和培训及辅导 预防研究到临床研究人员谁将继续发展， 艾滋病毒预防和药物滥用的执行、评价和宣传 在项目结束后在马来西亚采取治疗方法（具体目标3）。的 研究结果将为政府制定艾滋病政策和提供支持提供信息 预防和药物滥用治疗工作，可能还包括 其他西太平洋国家。

DESCRIPTION (provided by applicant): Combining drug abuse and HIV risk reduction counseling with opioid agonist maintenance treatment (OMT) or antagonist maintenance treatment with naltrexone (NMT) is effective for reducing illicit drug use and preventing HIV transmission associated with heroin dependence, but support for NMT remains tenuous and OMT is not currently available in many Western Pacific countries (e.g., Malaysia, Indonesia and Singapore) where heroin addiction and HIV infection are epidemic and closely linked with injection drug use (IDU) and high-risk sexual behaviors among addicts. Promising results of NMT in Malaysia have created interest in evaluating OMT using buprenorphine (BMT) and comparing the efficacy of counseling alone and counseling combined with BMT or NMT. We are proposing a 24-week, randomized double blind clinical trial to evaluate the efficacy for maintaining abstinence and reducing HIV risk behaviors of manual-guided, HIV risk reduction and drug counseling (DC-HIV) alone or when combined with BMT or NMT for recently detoxified and currently abstinent heroin dependent patients (N=l80) in Malaysia (Specific Aim 1). The study will allow evaluation of 3 hypotheses: DC-HIV plus naltrexone is superior to DC-HIV alone; DC-HIV plus buprenorphine is superior to DC-HIV alone; and DC-HIV plus naltrexone is superior to DC-HIV plus buprenorphine. Primary outcome measures, assessed by 3x/wk urine toxicology testing and self-report, include resumption of heroin use, 1 or 3 weeks continuous relapse and reductions in HIV risk behaviors. The project will also evaluate the characteristics of treatment-seeking heroin addicts in Malaysia (including specific risk behaviors and patterns of HIV risk behaviors; prevalence of psychiatric and other medical comorbidity; and patterns of social, family, vocational, and criminal activity and service needs--Specific Aim 2). This data will be used to revise the DC-HIV manual to address the specific circumstances and risk behaviors of Malaysian heroin addicts. Finally, the project will also provide clinical training for health professionals and training and mentoring in drug abuse treatment and HIV prevention research to clinical researchers who will continue development, implementation, evaluation and dissemination of HIV prevention and drug abuse treatment approaches in Malaysia after the project ends (Specific Aim 3). The results of the study will inform government policy and support for HIV prevention and drug abuse treatment efforts in Malaysia and possibly also in other Western Pacific countries.