Intervention of HIV, Drug Use and the Criminal Justice System in Malaysia

描述（由申请人提供）：尽管有各种各样的艾滋病预防方法和相关研究，但十年来，全球每天有11,000例新的艾滋病诊断。注射吸毒者仍然是一个目标人群，因为他们是新发艾滋病毒感染的重要传播媒介，这些感染是通过可预防的与药物和性有关的艾滋病毒风险行为发生的。解决化学品依赖的刑事司法方法主要是监禁，导致艾滋病毒阳性患者集中在监狱环境中。一些以证据为基础的减少艾滋病毒风险干预措施现在作为完整的行为干预一揽子措施广泛提供。很少有基于证据的干预措施为艾滋病毒阳性囚犯从监狱过渡到社区环境而设计和调整。没有一个使用集成模型。美沙酮维持治疗（MMT）是一种以证据为基础的治疗阿片类药物依赖的药理学方法，也没有被广泛实施，作为释放囚犯降低艾滋病毒风险的二级干预措施。MMT已被证明可以降低与毒品有关的注射风险，但对性风险的影响却微乎其微。公共卫生当局努力实施最佳做法干预措施，以调解注射吸毒者之间的艾滋病毒传播，他们经常与刑事司法系统打交道。作为我们具体目标的一部分，我们建议：1)创建一种新的监狱释放行为咨询干预措施，即“积极转变”（PT），将针对释放囚犯的艾滋病毒+整体健康康复项目（HHRP+）调整到社区和马来西亚范围内，以改善健康结果并减少艾滋病毒传播行为；2)采用2x2多因子设计，对符合DSM- IV阿片类药物依赖标准的HIV阳性囚犯进行前瞻性随机对照试验，比较常规监狱释放（对照组）与单独的积极过渡、单独的MMT或MMT加积极过渡的组合，以确定最佳的监狱释放干预。该试验的结果将告知公共卫生当局如何最好地减少阿片类药物依赖的释放的艾滋病毒阳性囚犯中的艾滋病毒传播。一个由美国和马来西亚调查人员组成的小组以前在囚犯、艾滋病毒感染、药物滥用治疗和行为干预研究方面进行了大量合作和专业知识，汇集了他们的集体经验，协助回答有关对释放的艾滋病毒阳性囚犯进行循证干预的重要公共卫生问题。

DESCRIPTION (provided by applicant): Despite a wide array of HIV prevention approaches and related research, there is a decade-long trend of 11,000 new HIV diagnoses each day globally. Injection drug users (IDUs) remain a target population as they represent a significant vector for the transmission of new HIV infections, which occur through preventable drug- and sex- related HIV risk behaviors. The criminal justice approach to addressing chemical dependency has primarily been incarceration, resulting in concentration of HIV+ in prison settings. A number of evidence-based HIV risk reduction interventions are now widely available as complete behavioral intervention packages. Very few evidence-based interventions have been designed and adapted for HIV+ prisoners transitioning from the prison to the community setting. None have used integrated models. Methadone maintenance treatment (MMT), an evidence-based pharmacological approach to treating opioid dependence, has also not been widely implemented as a secondary HIV risk reduction intervention for released prisoners. MMT has been demonstrated to reduce drug- related injection risks, but arguably has little influence on sexual risk-taking. Public health authorities struggle to implement best practice interventions to intercede with HIV transmission among IDUs, who routinely interface with criminal justice system. As part of our specific aims, we propose: 1) to create a new prison-release behavioral counseling intervention, "Positive Transitions" (PT), by adapting the Holistic Health Recovery Project for HIV+s (HHRP+) for prisoners released to the community and within the Malaysian context in order to improve health outcomes and reduce HIV transmission behaviors; and 2) using a 2x2 multi-factorial design, to conduct a prospective, randomized controlled trial of HIV+ prisoners who meet DSM- IV criteria for opioid dependence to compare prison-release as usual (control group) versus Positive Transitions alone, MMT alone, or the combination of MMT plus Positive Transitions to determine the optimal prison-release intervention. Results from this trial will inform public health authorities about how to best reduce HIV transmission among released HIV+ prisoners with opioid dependence. A team of U.S. and Malaysian investigators with significant previous collaboration and expertise with prisoners, HIV infection, substance abuse treatment and behavioral intervention research pools their collective experience to assist in answering important public health questions regarding evidence-based interventions for released HIV+ prisoners. PUBLIC HEALTH RELEVANCE: HIV+ prisoners with opioid dependence figure greatly in fueling the 11,000 new daily HIV infections globally. Effective prison-release programs that target HIV risk reduction for HIV+s have not been developed or studied using rigorous methodologies. This 2x2 multifactorial, randomized controlled trial of methadone maintenance treatment and an evidence-based behavioral intervention for HIV+s (Holistic Health Recovery Project) will advise public health authorities about how to best intervene with HIV+ prisoners who are transitioning from prison to the community.