Development of a methamphetamine early intervention

描述(由申请人提供)：甲基苯丙胺滥用与高危性行为以及男男性行为(MSM)中艾滋病毒的流行和发病有强烈和一致的流行病学联系，一些当局主张将甲基苯丙胺治疗作为艾滋病毒预防策略。然而，甲基苯丙胺干预措施没有在对照试验中进行评估，也没有在药物滥用治疗方案之外进行实施和评估。本申请建议进行初步调查，以使以前与MSM中性风险降低相关的甲基苯丙胺治疗干预措施用作从华盛顿州西雅图性传播疾病(STD)诊所招募的MSM的早期干预。60名到性病诊所就诊的使用甲基苯丙胺的男男性接触者将参加一项应急管理(CM)与不干预的随机对照试验。CM参与者将在12周内每周接受3次尿液甲基苯丙胺检测，如果尿液检测呈阴性，将收到价值不断上升的代金券；如果参与者的尿液甲基苯丙胺测试呈阳性或参与者错过尿液测试访问，代金券将被扣留。所有参与者都将在基线和为期6个月的6周间隔接受尿甲基苯丙胺测试和音频计算机辅助的性行为和物质使用自我访谈。参与者将在基线以及3个月和6个月的随访中接受艾滋病毒、梅毒、直肠淋病和衣原体感染以及咽部淋病的检测。这项研究将确定到性病诊所就诊的MSM启动和完成早期干预的频率，并将纵向衡量干预和对照参与者的不安全性行为。研究结果将确定建立和研究CM作为早期干预的可行性；确定干预是否有足够的前景来证明更大规模、明确的随机对照试验的合理性；并将为确定此类试验所需的参与者数量提供估计。

DESCRIPTION (provided by applicant): Methamphetamine abuse has a strong and consistent epidemiologic association with high-risk sexual behavior and both prevalent and incident HIV in men who have sex with men (MSM), and some authorities have advocated methamphetamine treatment as an HIV prevention strategy. However, methamphetamine interventions have not been evaluated in controlled trials, nor have they been implemented and assessed outside of substance abuse treatment programs. This application proposes preliminary investigations to adapt a methamphetamine treatment intervention previously associated with decreased sexual-risk taking among MSM for use as an early intervention among MSM recruited from sexually transmitted disease (STD) clinics in Seattle, Washington. Sixty methamphetamine-using MSM attending STD clinics will be enrolled in a randomized controlled trial of contingency management (CM) versus no intervention. CM participants will have their urine tested for methamphetamine 3 times weekly for 12 weeks, and will receive vouchers of escalating value when their urines test negative; vouchers will be withheld when participants' urines test positive for methamphetamine or participants miss urine testing visits. All participants will undergo urine methamphetamine testing and audio-computer assisted self-interviews on sexual behavior and substance use at baseline and at 6 week intervals for 6 months. Participants will be tested for HIV, syphilis, rectal gonorrhea and chlamydial infection, and pharyngeal gonorrhea at baseline and at 3 and 6 month follow-up. The study will determine how often MSM attending STD clinics will initiate and complete the early intervention, and will longitudinally measure unsafe sexual behaviors among intervention and control participants. Study results will determine the feasibility of instituting and studying CM as an early intervention; define whether the intervention is sufficiently promising to justify a larger, definitive randomized controlled trial; and will provide estimates for defining the number of participants such a trial would require.