VOUCHER-BASED INCENTIVES IN A PREVENTION SETTING

描述(由申请人提供)： 无家可归是一个严重困扰的问题；美国的城市和无家可归的药物滥用者面临着更大的风险。无家可归、同性恋和双性恋男性吸毒者(HGMSA)80%的艾滋病毒血清阳性，从事性交易，抵制药物滥用治疗。近30年来，Van Ness康复之家(VNRH)一直在为加利福尼亚州好莱坞的HGMSA提供治疗服务。1994年，VNRH开始通过其预防部门VNPD向未接受治疗的HGMSA提供艾滋病毒预防服务。由于VNPD的HGMSA中只有0.25%进入药物滥用治疗，我们的社区合作伙伴VNRH将克服HGMSA对进入治疗的抵抗力确定为主要战略目标。为了帮助他们实现他们的目标，我们寻求将基于凭单的强化疗法(VBRT)应用于不寻求治疗、高风险、无家可归的药物滥用者，并以增加接受治疗为目标。我们将评估VBRT在激励未接受治疗的HGMSA进入药物滥用治疗方面的效果，并通过评估HGMSA的VBRT是否可以由社区捐款资助和维持来确定VBRT的有效性。一项对照试验将VNPD的144例HGMSA随机分为VBRT组或对照组(72例/组)，为期24周，并计划在随机化后的7、9和12个月进行随访。VBRT小组将获得代金券，以换取他们进入免费药物滥用治疗的每一步。代金券将可用于兑换储存有社区捐款的现场交换商品。对照组将获得与VBRT组相同的免费治疗，但完成治疗进入步骤将不会得到加强。我们将主要衡量参与者进入药物治疗的比例、进入治疗所采取的步骤数量以及社区资助的VBRT计划的可持续性。我们将率先将VBRT应用于不寻求治疗的个人，并将VBRT整合到具有减少伤害理念的成熟预防计划中。我们的紧急增援将使用尚未得到足够重视的基本作战原则，塑造朝着治疗进入目标的行为。用社区捐款储备我们的现场商店，是使我们的VBRT自给自足的一步。总体而言，我们提议的研究有可能对洛杉矶同性恋和双性恋社区的公共健康产生重大影响。如果VBRT在激励社区预防计划中寻求HGMSA的非治疗人员进入药物滥用治疗方面是有效的，那么现有的预防计划可能会修改他们的方法，包括应急管理，并利用它来解决HGMSA每天面临的令人震惊的公共卫生问题。此外，我们还将探索通过当地社区和私人赞助商的捐款来资助和维持HGMSA的代金券计划是否可行。如果是，其他预防项目可能会采用我们的社区赞助的VBRT策略，帮助消除传播一种高效的药物滥用干预措施的主要障碍。

DESCRIPTION (provided by applicant): Homelessness is a significant problem plaguing; American cities and homeless substance abusers face increased risks. Homeless, gay and bisexual male substance abusers (HGMSA) suffer 80% HIV seroprevalence, engage in the sex trades and resist treatment for substance abuse. For almost 30 years, the Van Ness Recovery House (VNRH) has been providing treatment services to HGMSAs in Hollywood, CA. In 1994, VNRH began providing HIV prevention services to non-treatment seeking HGMSAs through the VNPD, its prevention division. Because only 0.25% of HGMSAs at VNPD enter substance abuse treatment, VNRH, our community partner, identified overcoming HGMSAs resistance to entering treatment as a major strategic goal. To help them meet their goal, we seek to apply voucher-based reinforcement therapy (VBRT), a treatment with proven clinical efficacy, to non- treatment seeking, high-risk, homeless substance abusers, with increasing treatment entry as the goal. We will assess the efficacy of VBRT in motivating non- treatment seeking HGMSAs to enter substance abuse treatment and determine the effectiveness of VBRT by evaluating whether VBRT for HGMSAs can be financed and sustained by community donations. A controlled trial will randomize 144 HGMSAs at VNPD to either VBRT or control groups (72/group) for 24 weeks, with planned follow up at 7, 9 and 12 months from randomization. The VBRT group will earn vouchers in exchange for each step they take toward entering, free substance abuse treatment. Vouchers will be redeemable for goods located in an on site exchange stocked with community donations. The control group will have the same access to free treatment as the VBRT group, but completing treatment entry steps will not be reinforced. We will measure primarily the proportion of participants entering drug treatment, the number of steps taken towards treatment entry and the sustainability of a community-financed VBRT program. We will be among the first to apply VBRT to non-treatment seeking individuals as well as to integrate VBRT into a well-established prevention program with a harm reduction philosophy. Our reinforcement contingencies will shape behavior towards the goal of treatment entry, using a basic operant tenet that has not received sufficient attention. Stocking our on site store with community donations takes a step towards making our VBRT self-sustaining. Overall, our proposed research has the potential to have a significant impact on the public health of the Los Angeles gay and bisexual community. If VBRT is efficacious for motivating non-treatment seeking HGMSAs in a community-based prevention program to enter substance abuse treatment, established prevention programs may modify their approaches to include contingency management, and use it to address the staggering public health problems HGMSAs face on a daily basis. Moreover, we will discover whether financing and sustaining a voucher program for HGMSAs through donations from the local community and private sponsors is feasible. If it is, other prevention programs may adopt our community-sponsored VBRT strategy, helping to remove a major obstacle to disseminating a highly efficacious intervention for substance abuse.