MMT CARE For HIV Prevention: A Randomized Controlled Trial

描述（由申请人提供）：我们提出了一项针对中国美沙酮维持治疗（MMT）项目的5年随机对照试验。应用组合预防的原则，拟议的干预措施（MMT CARE）将社会心理和行为成分整合到美沙酮维持的药理学框架中。将从四个省随机选择68家MMT诊所。每个诊所将招募6名服务提供者和36名客户，共计408名服务提供者和2，448名客户参与研究。68家诊所将随机分配至：1）MMT CARE干预组，或2）对照组（各34家诊所）。完成培训的服务提供者将与客户进行三次个人激励增强会议。将在基线和3、6、12、18和24个月随访时评价干预的有效性。服务提供者的结果将通过以下方面来衡量：1）改善对MMT协议的遵守; 2）减少偏见态度; 3）增加与客户的互动; 4）增加与客户关于降低风险的沟通。客户的结果将通过以下方式衡量：1）改善治疗依从性/保留率; 2）减少同时使用药物; 3）增加改变行为的动机; 4）改善心理健康; 5）增加积极支持; 6）减少艾滋病毒风险行为。 公共卫生相关性：注射吸毒是全球艾滋病毒流行的一个隐藏层面。中国的美沙酮维持治疗（MMT）计划正在迅速扩大，以解决药物滥用和艾滋病毒/艾滋病之间的关键联系。然而，它面临着多重挑战，包括辍学率高、同时吸毒率高以及客户需求与服务提供者技能之间的差距。该项目采用综合预防办法，以满足提高诊所服务质量、服务提供者-客户互动和客户治疗结果的迫切需要。收集的数据将成为循证干预的基础，可提供给中国700多家MMT诊所，并可能成为其他国家减少伤害项目的成功模式。

DESCRIPTION (provided by applicant): We propose a 5-year randomized controlled trial that targets methadone maintenance treatment (MMT) programs in China. Applying the principles of combination prevention, the proposed intervention (MMT CARE) integrates psychosocial and behavioral components into a pharmacological framework for methadone maintenance. A total of 68 MMT clinics will be randomly selected from four provinces. From each clinic, 6 service providers and 36 clients will be recruited, totaling 408 providers and 2,448 clients in the study. The 68 clinics will be randomized to: 1) a MMT CARE intervention group, or 2) a control group (34 clinics each). Service providers who complete the training will conduct three individual motivational enhancement sessions with clients. Efficacy of the intervention will be evaluated at baseline and at 3, 6, 12, 18, and 24-month follow- ups. The outcomes for service providers will be measured by: 1) improved adherence to MMT protocols; 2) decreased prejudicial attitudes; 3) increased interaction with clients; and 4) increased communications with clients about risk reduction. The outcomes for clients will be measured by: 1) improved treatment adherence/retention; 2) decreased concurrent drug use; 3) increased motivation for behavior change; 4) improved mental health; 5) increased positive support; and 6) reduced HIV risk behaviors. PUBLIC HEALTH RELEVANCE: Injecting drug use is a hidden dimension of the global HIV epidemic. China's methadone maintenance therapy (MMT) program is expanding rapidly to address a critical link between drug abuse and HIV/AIDS. However, it faces multiple challenges, including a high dropout rate, high concurrent drug use, and a gap between clients' needs and service providers' skills. This project uses a combination prevention approach to respond to the urgent need for improved quality of services at clinics, provider-client interactions, and client treatment outcomes. Collected data will form the foundation of an evidence-based intervention that can be delivered to over 700 MMT clinics in China, and will potentially serve as a successful model for harm reduction programs in other countries.