HIV Risk Reduction and Drug Abuse Treatment in Malaysia

马来西亚的艾滋病毒风险降低和药物滥用治疗

• 批准号: 6442237
• 负责人: Richard S Schottenfeld
• 金额: $ 36.33万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-30 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6442237
• 关键词: AIDS education /prevention; Malaysia; buprenorphine; cognitive behavior therapy; combination therapy; comorbidity; disease /disorder proneness /risk; drug abuse; drug abuse chemotherapy; drug abuse therapy; heroin; human subject; human therapy evaluation; naltrexone; patient oriented research; relapse /recurrence

DESCRIPTION (provided by applicant): Combining drug abuse and HIV risk reduction counseling with opioid agonist maintenance treatment (OMT) or antagonist maintenance treatment with naltrexone (NMT) is effective for reducing illicit drug use and preventing HIV transmission associated with heroin dependence, but support for NMT remains tenuous and OMT is not currently available in many Western Pacific countries (e.g., Malaysia, Indonesia and Singapore) where heroin addiction and HIV infection are epidemic and closely linked with injection drug use (IDU) and high-risk sexual behaviors among addicts. Promising results of NMT in Malaysia have created interest in evaluating OMT using buprenorphine (BMT) and comparing the efficacy of counseling alone and counseling combined with BMT or NMT. We are proposing a 24-week, randomized double blind clinical trial to evaluate the efficacy for maintaining abstinence and reducing HIV risk behaviors of manual-guided, HIV risk reduction and drug counseling (DC-HIV) alone or when combined with BMT or NMT for recently detoxified and currently abstinent heroin dependent patients (N=l80) in Malaysia (Specific Aim 1). The study will allow evaluation of 3 hypotheses: DC-HIV plus naltrexone is superior to DC-HIV alone; DC-HIV plus buprenorphine is superior to DC-HIV alone; and DC-HIV plus naltrexone is superior to DC-HIV plus buprenorphine. Primary outcome measures, assessed by 3x/wk urine toxicology testing and self-report, include resumption of heroin use, 1 or 3 weeks continuous relapse and reductions in HIV risk behaviors. The project will also evaluate the characteristics of treatment-seeking heroin addicts in Malaysia (including specific risk behaviors and patterns of HIV risk behaviors; prevalence of psychiatric and other medical comorbidity; and patterns of social, family, vocational, and criminal activity and service needs--Specific Aim 2). This data will be used to revise the DC-HIV manual to address the specific circumstances and risk behaviors of Malaysian heroin addicts. Finally, the project will also provide clinical training for health professionals and training and mentoring in drug abuse treatment and HIV prevention research to clinical researchers who will continue development, implementation, evaluation and dissemination of HIV prevention and drug abuse treatment approaches in Malaysia after the project ends (Specific Aim 3). The results of the study will inform government policy and support for HIV prevention and drug abuse treatment efforts in Malaysia and possibly also in other Western Pacific countries.

描述（由申请人提供）：结合药物滥用和艾滋病毒风险 通过阿片类激动剂维持治疗 (OMT) 进行减量咨询或 纳曲酮（NMT）拮抗剂维持治疗对于 减少非法药物使用并预防与以下相关的艾滋病毒传播 海洛因依赖，但对 NMT 的支持仍然薄弱，而且目前还没有 OMT 许多西太平洋国家（例如马来西亚、印度尼西亚和 新加坡）海洛因成瘾和艾滋病毒感染流行且密切相关 与注射吸毒 (IDU) 和高危性行为有关 瘾君子。 NMT 在马来西亚的可喜成果引起了人们的兴趣 使用丁丙诺啡 (BMT) 评估 OMT 并比较疗效 单独咨询和咨询与 BMT 或 NMT 相结合。我们正在提议一个 为期 24 周的随机双盲临床试验，评估疗效 保持禁欲并减少人工指导的艾滋病毒危险行为 单独或与 BMT 或联合使用时降低风险和药物咨询 (DC-HIV) 针对最近戒毒且目前戒断的海洛因依赖患者的 NMT (N=180)在马来西亚(具体目标1)。该研究将允许评估 3 假设：DC-HIV 加纳曲酮优于单独使用 DC-HIV； DC-HIV+ 丁丙诺啡优于单独使用 DC-HIV； DC-HIV 加纳曲酮是 优于 DC-HIV 加丁丙诺啡。主要结果指标，评估者 每周 3 次尿液毒理学测试和自我报告，包括恢复海洛因 使用后 1 或 3 周连续复发并减少 HIV 危险行为。这 项目还将评估寻求治疗的海洛因的特征 马来西亚的成瘾者（包括特定的危险行为和艾滋病毒风险模式 行为；精神疾病和其他医学合并症的患病率；和 社会、家庭、职业和犯罪活动和服务的模式 需求——具体目标 2)。该数据将用于修订 DC-HIV 手册 解决马来西亚海洛因的具体情况和危险行为 瘾君子。最后，该项目还将提供健康临床培训 药物滥用治疗和艾滋病毒方面的专业人员以及培训和指导 临床研究人员的预防研究将继续发展， 艾滋病毒预防和药物滥用的实施、评估和传播 项目结束后马来西亚的治疗方法（具体目标 3）。这 研究结果将为政府制定艾滋病毒政策和支持提供信息 马来西亚的预防和药物滥用治疗工作，也可能在 其他西太平洋国家。