Methadone maintenance and HIV risk in Ukraine

说明(申请人提供)：治疗阿片类药物依赖是减少艾滋病毒和其他传染病传播的重要途径，特别是在乌克兰，因为静脉注射阿片类药物是这些感染传播的主要途径。这项提案将在基辅城市肿瘤医院与阿拉巴马大学和科罗拉多大学的合作者一起完成。它将研究为期3个月的美沙酮维持疗程对50名阿片类药物依赖者(25名艾滋病毒阳性者和25名艾滋病毒阴性者)的接受性和影响。拟议的工作将建立在1999-2000年约翰霍普金斯大学汉弗莱研究员期间与乌克兰联合首席调查员塞尔吉·德沃亚克医学博士建立的关系上，当时他在宾夕法尼亚成瘾治疗和研究中心与伍迪和梅茨格博士共度时光。它还将扩大伍迪、舒马赫和布斯博士在俄罗斯和乌克兰正在进行的阿片类药物依赖的药物治疗和降低风险行为干预的研究。主要目的是：1)衡量艾滋病毒携带者和艾滋病毒携带者接受和遵守3个月美沙酮维持疗程的情况；2)衡量3个月美沙酮疗程在减少阿片类药物使用和艾滋病毒危险行为方面的影响。次要目标是：1)评估调查小组获得研究结果指标的程度；2)评估为期3个月的美沙酮维持疗程在多大程度上减少了非法活动，改善了就业和精神症状；3)确定了美沙酮治疗完成后的短期结果；以及4)获得了研究患者中乙肝和丙型肝炎患病率的初步数据。该提案涉及国家卫生研究院的两个优先领域：艾滋病毒预防和药物滥用。它将提供关于美沙酮短期维持疗程在尚未评估这种治疗的文化背景下的可接受性和有效性的试点数据，关于在基辅对阿片依赖者进行药理学研究的可行性，并将加强基辅调查人员对未来艾滋病毒预防和治疗研究的研究能力。

DESCRIPTION (provided by applicant): Treatment of opioid dependence is an important way to reduce the spread of HIV and other infectious diseases, particularly in Ukraine since intravenous opioid use is the major way these infections are being spread. This proposal will be done at the Kiev City Narcology Hospital with collaborators from the University of Alabama and the University of Colorado. It will study the acceptability and impact of a 3-month course of methadone maintenance on 50 persons with opioid dependence, 25 who are HIV+ and 25 HIV-. The proposed work will build upon a relationship that was established with the Ukrainian Co-Principal Investigator, Sergiy Dvoryak, MD, during his Humphrey Fellowship at Johns Hopkins in 1999-2000 when he spent time with Drs. Woody and Metzger at the Penn Addiction Treatment and Research Center. It will also extend studies of pharmacologic treatment for opioid dependence and risk reduction behavioral interventions that are being done by Drs. Woody, Schumacher and Booth in Russia and Ukraine. Primary aims are to: 1) Measure the acceptability and compliance with a 3-month course of methadone maintenance in HIV+ and HIV- patients; and 2) Measure the impact of a 3-month course of methadone in reducing opioid use and HIV risk behavior. Secondary aims are to: 1) Assess the degree to which the investigative team obtains study outcome measures; 2) Assess the degree to which the 3-month course of methadone maintenance reduces illegal activities and improves employment and psychiatric symptoms; 3) Determine short term outcome after completion of methadone treatment; and 4) Obtain pilot data on the prevalence of hepatitis B and C among study patients. This proposal addresses two priority areas of NIH: HIV prevention and substance abuse. It will provide pilot data on the acceptability and efficacy of a short term course of methadone maintenance in a cultural setting where this treatment has not been evaluated, on the feasibility of conducting a pharmacological study of opioid dependent persons in Kiev, and will enhance research capabilities of Kiev investigators for future HIV prevention and treatment studies.