Patterns of Changing Risk Behavior in the CIDUS-3 Drug Users Intervention Trial

描述(申请人提供)：注射吸毒是一个严重的公共卫生问题，导致血液传播感染，包括HBC，丙型肝炎病毒和艾滋病毒。尽管在预防艾滋病毒/艾滋病和肝炎方面取得了进展，但注射毒品的使用继续直接通过共用注射设备造成新的感染，并通过注射吸毒者向非注射毒品性伴的性传播间接造成新的感染。对注射吸毒者的行为干预是全面艾滋病毒预防战略的重要组成部分。与标准干预措施相比，加强对注射吸毒者的干预措施只显示出不大的效果。改善对注射吸毒者的干预措施的关键可能在于了解对这些干预措施的反应差异。潜变量方法(也称为混合建模)可以用来识别具有相似反应模式的个体的子组。这些方法通常被称为以人为中心，而不是传统的以变量为中心的方法。为了更好地了解艾滋病毒预防干预措施如何影响注射吸毒者的注射和性行为，我们将对第三次注射吸毒者合作研究/吸毒者干预试验(CIDUS-3/DUIT)的数据进行二次分析。这项研究招募了美国五个城市的年轻注射吸毒者，以测试一种新型的同伴教育干预(PEI)相对于对艾滋病毒/丙型肝炎风险行为变化的注意力控制。我们将使用混合建模方法，包括潜在类别分析、增长混合建模和潜在转变分析，来分析项目结果。我们的目标是确定干预对其最有利的特定注射吸毒者亚群。此外，我们寻求确定团体成员的预测因素，这将使我们能够将个人分配到最有可能产生影响的干预行动中。拟议的分析将增加我们对标准和强化干预措施对注射和性危险行为的影响的了解，并导致提出改善注射吸毒者干预工作的建议。这一结果还可能对制定其他人群预防干预措施的战略产生更广泛的影响。

DESCRIPTION (provided by applicant): Injection drug use is a serious public health problem, leading to blood-borne infections including HBC, HCV, and HIV. In spite of advances in the prevention of HIV/AIDS and hepatitis, injection drug use continues to contribute to new infections both directly through the sharing of injection equipment, and indirectly through sexual transmission from injection drug users (IDUs) to non-IDU sex partners. Behavioral interventions with IDUs are an important component of a comprehensive HIV prevention strategy. Enhanced interventions with IDUs have shown only modest effects over and above standard interventions. The key to improving interventions with IDUs may lie in understanding variations in responses to these interventions. Latent variable approaches (also known as mixture modeling) can be used to identify subgroups of individuals with similar response patterns. These approaches are often referred to as person-centered, in contrast to the traditional variable-centered approaches. To better understand how HIV prevention interventions influence injecting and sexual behavior of IDUs, we will conduct secondary analyses of data from the Third Collaborative Injection Drug Users Study / Drug Users Intervention Trial (CIDUS-3/DUIT). This study recruited young injection drug users in five U.S. cities to test a novel peer education intervention (PEI) against an attention control on changes in HIV/HCV risk behavior. We will use mixture modeling approaches, including latent class analysis, growth mixture modeling, and latent transition analysis, to analyze program outcomes. Our aim is to identify specific subgroups of IDUs for whom the intervention was most beneficial. Moreover, we seek to identify predictors of group membership which would enable us to assign individuals to the intervention that is most likely to have an impact. The proposed analyses will increase our understanding of the effects of the standard and enhanced interventions on injection and sexual risk behavior, and lead to recommendations for improving intervention efforts with injection drug users. The results may also have wider implications for strategizing prevention interventions with other populations.