Evaluation Of Treatments Of Drug Dependence In HIV Infec

该项目评估了减少药物滥用者艾滋病毒危险行为的方法，并评估了已经感染艾滋病毒的阿片类药物依赖的药物和行为治疗的安全性和有效性。我们已经完成了一项随机临床试验，检验是否可以通过在基于凭证的应急管理中增加认知-行为应对技能和复发预防干预来实现持续的艾滋病毒保护行为。市中心美沙酮维持的可卡因滥用者接受了以下教育：1)识别并寻找不会带来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，制定以问题为重点和以情感为重点的适应性应对反应。研究样本(n=81)为女性52%，非裔美国人70%，年龄37.9？7.0岁。艾滋病毒危险行为大幅减少：49.4%的人停止注射毒品，51.9%的人停止共用针头，27.2%的人停止无保护措施的性行为，25.9%的人停止用性行为换取金钱或毒品。与对照组相比，接受CBT治疗的参与者更有可能停止无保护措施的性行为(OR=5.44，95%CI1.14-26.0，p=0.034)，但在调整药物阴性尿液后，这种影响有所减弱。这些结果表明，在行为干预的基础上，美沙酮的维持对减少HIV危险行为有广泛的益处，而CBT对减少性危险行为的额外益处有限。

This project assesses methods for decreasing HIV-risk behaviors in substance abusers, and assesses the safety and efficacy of pharmacological and behavioral treatments for opioid dependence in those already infected with HIV. We have completed a randomized clinical trial examining whether sustained HIV-protective behaviors can be achieved by adding a cognitive-behavioral coping-skills and relapse-prevention intervention to voucher-based contingency management. Inner-city methadone-maintained cocaine abusers 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. The study sample (n=81) was 52% female, 70% African American, and 37.9 ? 7.0 years old. There were substantial decreases in HIV-risk behaviors: 49.4% stopped injection drug use, 51.9% stopped sharing needles, 27.2% stopped unprotected sex, and 25.9% stopped trading sex for money or drugs. Participants receiving CBT were more likely to stop unprotected sex relative to controls (OR=5.44, 95% CI 1.14-26.0, p=0.034), but this effect was reduced when adjusted for drug-negative urines. These results suggest broad beneficial effects of methadone maintenance augmented with behavioral interventions for reducing HIV risk behaviors, with limited additional benefit from CBT for reduction of sexual risk behaviors.