Long Term Injection Cessation among Injection Drug Users (IDUs)

描述（由申请方提供）：本研究的主要目的是增加对注射吸毒自然史的了解，特别关注长期注射停止，使用来自艾滋病与静脉内经历（ALIVE）研究的数据，该研究是马里兰州巴尔的摩的一项基于社区的注射吸毒者（IDUs）队列。针对注射吸毒者的大多数艾滋病毒预防战略侧重于减少与注射吸毒有关的频率和危害。虽然这些努力很重要，但注射吸毒者艾滋病毒预防的最终目标是长期停止注射。以前关于注射停止的研究主要集中在预测短期停止（即6个月至1年）的个人因素。对与短期戒烟相关的个人因素的研究没有考虑到维持较长时间戒烟的因素或创造鼓励和维持戒烟环境的更广泛的社会因素。由于成瘾的特点往往是在相对较短的时间内戒断和复吸，短期戒烟的预测因素可能不同于长期戒烟的预测因素，短期戒烟可能不会导致所有注射吸毒者的长期康复。目前的研究将嵌套在ALIVE研究中，该研究自1988年以来在巴尔的摩市招募并随访了近4,000名主要是非洲裔美国人的注射吸毒者。本研究的具体目的是：1）描述注射吸毒者中注射和非注射吸毒的纵向模式，包括长期停止注射; 2）确定注射吸毒者中长期停止注射的个人水平预测因素; 3）确定注射吸毒者中长期停止注射的社区水平预测因素。我们提出了一个定性，纵向和多层次的分析相结合，调查长期注射停止。每一个目标都将通过与已实现长期戒烟的注射吸毒者进行反复深入访谈进行定性探讨。定量分析将开始，首先使用ALIVE研究中收集的丰富纵向数据，以确定长期戒烟（定义为至少3年不注射）的频率，以及1988年至2007年的其他注射和非注射吸毒模式。我们将采用嵌套病例对照设计，以确定长期戒烟的纵向预测因素，以及维持戒烟的因素，在个人水平。最后，我们将使用地理信息系统（GIS）软件进行多层次分析，将个人住宅数据与美国人口普查和其他行政社区级数据联系起来，以研究巴尔的摩市促进和维持长期停止注射的社区特征（例如社会经济劣势）。拟议的研究将为旨在促进和维持注射吸毒者长期停止注射的艾滋病毒和药物使用干预措施提供信息。项目叙述。本研究的主要目的是增加对注射吸毒自然史的了解，特别关注长期注射停止。我们提出了一个定性的，纵向的，多层次的分析相结合，调查个人和社区层面的长期注射吸毒者（IDUs）之间的注射停止预测。拟议的研究将为旨在促进和维持注射吸毒者长期停止注射的艾滋病毒预防和药物使用干预措施提供信息。

DESCRIPTION (provided by applicant): The main objective of this study is to increase understanding of the natural history of injection drug use, with a specific focus on long-term injection cessation, using data from the AIDS Link to the IntraVenous Experience (ALIVE) study, a community-based cohort of injection drug users (IDUs) in Baltimore, Maryland. The majority of HIV prevention strategies directed at IDUs focus on reducing the frequency and harms associated with injection drug use. While these efforts are important, the ultimate goal of HIV prevention for IDUs is long-term injection cessation. Previous research on injection cessation has focused primarily on individual-level factors that predict short periods of cessation (i.e. 6 months to one year). Studies of individual factors associated with short-term cessation do not take into account the factors that maintain longer periods of cessation or the broader social factors that create environments that encourage and sustain cessation. Since addiction is often characterized by periods of abstinence and relapsed use within relatively short time spans, predictors of short-term cessation may differ from predictors of long-term cessation and short-term cessation may not lead to long term recovery for all IDUs. The current study will be nested within the ALIVE study, which has enrolled and followed nearly 4,000 predominantly African-American IDUs since 1988 in Baltimore City. The specific aims of this study are: 1) To characterize the longitudinal patterns of injection and non-injection drug use, including long term injection cessation, among IDUs; 2) To identify individual-level predictors of long-term injection cessation among IDUs; and 3) To determine neighborhood- level predictors of long-term cessation of injection among IDUs. We propose a combination of qualitative, longitudinal, and multilevel analyses to investigate long-term injection cessation. Each aim will be explored qualitatively with iterative in-depth interviews with IDUs who have achieved long-term cessation. The quantitative analysis will begin by using the rich longitudinal data collected in the ALIVE study to determine the frequency of long-term cessation, defined as no injection for at least 3 years, as well as other injection and non-injection drug use patterns from 1988 to 2007. We will employ a nested case-control design to determine the longitudinal predictors of long-term cessation, as well as factors that maintain cessation, at the individual- level. Finally we will conduct multilevel analyses using Geographic Information System (GIS) software to link individual residential data to US Census and other administrative neighborhood-level data to examine the neighborhood characteristics (e.g. socio-economic disadvantage) in Baltimore City that promote and maintain long-term injection cessation. The proposed study will inform HIV and substance use interventions aimed at promoting and maintaining long-term injection cessation among IDUs. Project Narrative. The main objective of this study is to increase understanding of the natural history of injection drug use, with a specific focus on long-term injection cessation. We propose a combination of qualitative, longitudinal, and multilevel analyses to investigate the individual and neighborhood-level predictors of long-term injection cessation among injection drug users (IDUs). The proposed study will inform HIV prevention and substance use interventions aimed at promoting and maintaining long-term injection cessation among IDUs.