Evaluation Of Treatments Of Drug Dependence In HIV Infected Patients

静脉注射毒品是艾滋病毒传播的主要媒介。 应急管理是一种行为治疗，参与者可以获得戒毒奖金，已被证明可以减少非法药物的使用，是一种有效的药物依赖治疗。 我们评估了应急管理是否也能减少HIV风险行为。 参与者是美沙酮维持阿片类药物和可卡因使用门诊患者（n = 116），随机分配到基于奖品的应急管理（获奖者有机会抽奖）或对照组。 非偶然的对照组接受与实验组相匹配的抽奖，但独立于他们的药物使用。 两组在整个治疗过程中接受美沙酮和个人咨询。 参与者在研究期间每两周以书面问卷形式填写一次艾滋病毒风险行为量表（HRBS）。 中介分析进行，以确定是否在治疗过程中从阿片类药物和可卡因戒断介导的应急管理HRBS评分的影响。 结果表明，艾滋病毒的危险行为，HRBS评分测量，治疗组随着时间的推移，显着不同，随着时间的推移，HRBS评分下降在应急管理组在更大程度上比非应急控制组。 在应急管理治疗期间，应急管理组的参与者同时出现可卡因/阿片类药物阳性尿液标本的比率也显著低于非应急对照组。 治疗条件和HRBS评分之间的关系介导的治疗期间禁欲。 针对可卡因和海洛因使用的应急管理大大减少了与感染或传播艾滋病毒风险增加相关的注射相关吸毒行为。

Intravenous drug use is a major vector of HIV transmission. Contingency management, a behavioral treatment in which participants earn reinforcers for drug abstinence, has been shown to reduce the use of illicit drugs and to be an effective treatment of drug dependence. We assessed whether contingency management also reduces HIV-risk behaviors. Participants were methadone-maintained opiate- and cocaine-using outpatients (n = 116) randomly assigned to prize-based contingency management (the reinforcers were the opportunity to draw for prizes) or to a control group. The noncontingent control group received prize draws matched to the experimental group, but independent of their drug use. Both groups received methadone and individual counseling throughout treatment. Participants completed the HIV-Risk Taking Behaviour Scale (HRBS) in written questionnaire form every two weeks during the study. A mediation analysis was conducted to determine whether during-treatment abstinence from opiates and cocaine mediated the effect of contingency management on HRBS scores. The results showed that HIV risk behaviors, as measured by HRBS scores, differed significantly by treatment group over time, with HRBS scores decreasing over time in the contingency management group to a greater extent than in the noncontingent control group. Participants in the contingency management group also had significantly lower rates of simultaneous cocaine/opiate-positive urine specimens than those in the noncontingent control group during contingency management treatment. The relationship between treatment condition and HRBS scores was mediated by during-treatment abstinence. Contingency management targeted toward cocaine and heroin use produces significant reductions in injection-related drug-taking behaviors associated with heightened risk for getting or transmitting HIV.