VOUCHER-BASED INCENTIVES IN A PREVENTION SETTING

描述(由申请人提供)： 无家可归是困扰美国城市的一个重大问题，无家可归物质滥用者面临的风险增加。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提供以社区为基础的艾滋病毒预防服务。为行为改变提供积极激励的应急管理干预措施可能特别适合这一被剥夺公民权的高风险队列。具体地说，基于凭证的激励疗法(VBRT)可能特别有效，因为它们已经建立了增加亲社会行为的效力，这些行为成功地与吸毒竞争，并减少了药物使用。一项随机对照试验将在VNPD将144名未寻求治疗的HGMSA分配到VBRT组或对照组(72人/组)，为期24周，并计划在随机后的7、9和12个月进行随访。VBRT小组将获得代金券，以换取完成亲社会和健康行为和/或提交药物阴性尿液和酒精阴性呼气样本。位于现场代金券商店的商品可以兑换代金券。控制组将收到关于所做行为以及尿液分析和呼气酒精测试的反馈，但不会收到这些行为的代金券积分。我们将评估VBRT干预在这些在VNPD接受服务的未接受治疗的HGMSA中增加亲社会和健康行为以及减少药物滥用的效果。我们还将评估VBRT对符合减少伤害方法的其他治疗变化措施的影响，包括减少精神症状、减少注射药物使用和高危性行为、增加对预防规划的参与、改善总体功能(医疗/社会/职业)的不同领域，以及增加对变化的准备。此外，我们还将研究基线参与者特征是否能预测VBRT的结果。将VBRT应用于寻求HGMSA的非治疗，以及将VBRT整合到具有减少伤害理念的成熟预防计划中，都是高度创新的。我们的应急增援也将塑造更复杂行为的行为步骤，采用一个尚未得到足够关注的基本作战原则。总体而言，我们提议的研究有可能对洛杉矶无家可归者、同性恋和双性恋社区的公共健康产生重大影响。如果VBRT在社区预防计划中有效地激励不寻求HGMSA治疗的人增加亲社会和健康行为并减少药物/酒精使用，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。

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 community-based HIV prevention services to non-treatment seeking HGMSAs through the VNPD, its prevention division. Contingency management interventions providing positive incentives for behavior change may be particularly well suited for this disenfranchised, high-risk cohort. Specifically, voucher-based incentive therapies (VBRT) may be particularly effective since they have established potency for increasing prosocial behaviors that successfully compete with taking drugs and for reducing drug use. A randomize, controlled trial will assign 144 non-treatment seeking 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 completing prosocial and healthy behaviors and/or submitting drug-negative urine and alcohol-negative breath samples. Vouchers will be redeemable for goods located in an onsite voucher store. The control group will receive feedback regarding behaviors performed and urinalysis and breath alcohol tests, but will not receive voucher points for these behaviors. We will assess the efficacy of the VBRT intervention for increasing prosocial and healthy behavior and reducing substance abuse among these non-treatment seeking HGMSAs receiving services at VNPD. We will also assess the impact of VBRT on other measures of therapeutic change consistent with a harm reduction approach, including reduction of psychiatric symptoms, decreased injection drug use and high-risk sexual behavior, increased participation in prevention programming, improvement in different domains of overall functioning (medical/social/vocational), and increased readiness to change. Additionally, we will examine whether baseline participant characteristics predict VBRT outcomes. Applying VBRT to non-treatment seeking HGMSAs as well as integrating VBRT into a well-established prevention program with a harm reduction philosophy are both highly innovative. Our reinforcement contingencies will also shape behavioral steps towards more complex behaviors, employing a basic operant tenet that has not received sufficient attention. Overall, our proposed research has the potential to have a significant impact on the public health of the Los Angeles homeless, gay and bisexual community. If VBRT is efficacious for motivating non-treatment seeking HGMSAs in a community-based prevention program to increase prosocial and healthy behaviors and decrease drug/alcohol use, 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.