HIV Risk Reduction and Drug Abuse Treatment in Malaysia

描述(申请人提供)：药物滥用与艾滋病毒风险相结合 阿片类激动剂维持治疗(OMT)或 纳曲酮(NMT)的拮抗剂维持治疗是有效的 减少非法药物使用和预防与以下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目前不是 在许多西太平洋国家/地区(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且密切相关 与注射吸毒和高危性行为有关 瘾君子。马来西亚NMT的良好结果引起了人们对 丁丙诺啡(BMT)治疗OMT的疗效比较 单独咨询和咨询结合BMT或NMT。我们正在提议一项 为期24周的随机双盲临床试验，以评价其疗效 手动引导的HIV患者保持禁欲和减少HIV危险行为 单独或与骨髓移植或联合应用降低风险和药物咨询(DC-HIV) 新近脱毒和目前正在戒断的海洛因依赖者的NMT (n=180)马来西亚(具体目标1)。这项研究将允许对3个 假设：DC-HIV加纳曲酮优于单独DC-HIV；DC-HIV加 丁丙诺啡优于单用DC-HIV；DC-HIV+纳曲酮优于 优于DC-HIV加丁丙诺啡。主要结果衡量标准，由 每周3次尿毒学检测和自我报告，包括海洛因的恢复 使用，1或3周连续复发和减少艾滋病毒危险行为。这个 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(包括艾滋病毒风险的具体危险行为和模式 行为；精神疾病和其他医学共病的患病率；以及 社会、家庭、职业和犯罪活动及服务的模式 需求--具体目标2)。这些数据将用于修订DC-HIV手册，以 处理马来西亚海洛因的具体情况和危险行为 瘾君子。最后，该项目还将为保健人员提供临床培训。 药物滥用治疗和艾滋病毒方面的专业人员及培训和指导 将预防研究交给临床研究人员，他们将继续开发， 艾滋病毒预防和药物滥用的实施、评价和传播 项目结束后在马来西亚的治疗方法(具体目标3)。这个 研究结果将为政府的政策和对艾滋病毒的支持提供参考 马来西亚的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.