Evaluation Of Treatments Of Drug Dependence In HIV Infec

我们最近完成了一项将应急管理与认知行为疗法(CBT)相结合的随机临床试验，以减少(可卡因和海洛因)双重依赖门诊患者的药物使用。这项研究的第二个目标是检查是否通过将CBT添加到基于凭证的应急管理来实现持续的艾滋病毒保护行为。接受CBT干预的市中心美沙酮维持可卡因滥用者接受了以下教育：1)识别并寻找不存在艾滋病毒风险的强化来源；2)针对可能引发艾滋病毒危险行为的一般和药物特定应激源，制定适应性、注重问题和注重情感的应对反应。目前正在进行分析，将在这一临床样本中检查压力、应对策略和艾滋病毒危险行为之间的关系，并确定在研究过程中接受CBT作为研究干预的一部分的参与者的艾滋病毒危险行为变化是否有所不同。 另一项研究包括初步验证一种简短的筛查工具，用于确定艾滋病毒阳性住院患者目前的阿片类药物依赖。对曾有海洛因使用史的艾滋病住院患者进行8项问卷调查，评估阿片类药物依赖的耐受性、戒断和强迫使用等方面；这些患者提供尿样，现场检测阿片类药物的存在，并对他们进行阿片类药物戒断症状评估。为了确定具有可接受有效性的筛查工具的最短版本，以识别当前阿片类药物依赖(尿阿片类药物阳性和/或阿片类药物戒断症状)，计算了不同简短版本问卷的敏感性、特异性和阳性预测值。问卷由4个问题组成，敏感度为74.1%，特异度为64.4%，阳性预测值为71.4%。这些结果为进一步开发和验证艾滋病毒阳性患者阿片类药物依赖的短期筛查提供了起点。

We recently completed a randomized clinical trial of the efficacy combining contingency management with cognitive behavioral therapy (CBT) for reducing drug use in dually (cocaine- and heroin-) dependent outpatients. A secondary objective of this study is to examine whether sustained HIV-protective behaviors are achieved by adding CBT to voucher-based contingency management. Inner-city methadone-maintained cocaine abusers receiving the CBT intervention were taught: 1) to identify and seek out sources of reinforcement that do not carry risks of HIV; and 2) to develop adaptive problem-focused and emotion-focused coping responses to general and drug-specific stressors that might otherwise trigger HIV-risk behaviors. Analyses are currently underway that will examine the relationship between stress, coping strategies, and HIV risk behaviors in this clinical sample, and determine whether changes in HIV risk behaviors over the course of the study differed for participants who received CBT as part of their study intervention. Another study included preliminary validation of a brief screening instrument for identifying current opiate dependence in HIV-positive inpatients. Patients admitted to an inpatient AIDS ward who indicated past heroin use were administered an 8-item questionnaire assessing aspects of opiate dependence such as tolerance, withdrawal, and compulsive use; these patients provided a urine sample that was tested on-site for the presence of opiates, and they were assesed for symptoms of opioid withdrawal. With the goal of determining the shortest version of the screening instrument with acceptable validity for identifying current opiate dependence (urine positive for opiates and/or symptoms of opiate withdrawal), the sensitivity, specificity, and positive predictive value of various short versions of the questionnaire were calculated. The version of the questionnaire selected consisted of four questions and had sensitivity of 74.1%, specificity 64.4%, and positive predictive value of 71.4%. These results provide a starting point for further development and validation of short screens for opiate dependence in HIV-positive patients.